DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Suprasellar mass.
POSTOPERATIVE DIAGNOSIS: Suprasellar mass.
OPERATION PERFORMED:
1. Right frontotemporal orbital zygomatic craniotomy.
2. Right optic nerve decompression and partial clinoidectomy.
3. Resection of tumor.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
COMPLICATIONS: None.
SPECIMEN: Craniopharyngioma.
ANESTHESIA: General.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman who presented with a history of visual field defect and endocrine dysfunction. He was found to have a large suprasellar mass with compression of the optic chiasm consistent with a possible craniopharyngioma. The patient understands the options of observation versus surgery versus radiation and the option of surgery followed by radiation. The patient understands the risks and benefits of the procedure including, but not limited to, blindness, hematoma, infection, seizures, CSF leak, recurrence of tumor, need for reoperation and stroke. The patient signed consent for the procedure of resection of tumor.
DESCRIPTION OF OPERATION: The patient was intubated and placed in the supine position with the head and neck in the head holder. A right frontotemporal craniotomy flap was marked and was prepped and draped in a sterile fashion. An incision was then made with a 10 blade scalpel and Bovie coagulators and the scalp along with the temporalis muscles was reflected anteriorly and inferiorly.
After that, the Midas Rex was then used to drill a McCarty bur hole. Then, another hole was made in the temporal zone. Craniotomy was then turned with a Midas Rex and then the zygomatic arch was spotted and another cut was made in the zygomatic arch. The orbit was also dissected free and the maxillary process was also dissected. Another cut was made and a cut was made at the level of the orbital roof. This allowed performance of a one-piece frontal-orbital, temporozygomatic osteotomy.
After removal of the bone, hemostasis was achieved. The rest of the sphenoid wing was drilled out, and subsequently, the dura was tacked up to the bone. The dura was opened in a C-shaped fashion, and under microscope, microdissection and illumination to the sylvian fissure was then gradually opened from proximal to distal. Then, with the use of the Midas Rex, decompression of the right optic nerve was accomplished by drilling the optic canal. The clinoid process was also partially drilled out so that the opticocarotid triangle was increased significantly.
The tumor was identified between the carotid and the oculomotor nerve, and the tumor was entered and was progressively debulked by using bipolar coagulators and suction. After the debulking of the tumor was completed between the third nerve and the carotid, the tumor was attacked also in the optic-carotid triangle. The tumor appeared to be quite solid and was progressively removed. The superior hypophyseal arteries were dissected and preserved completely on the right side.
Then, attention was diverted to the lamina terminalis, which was opened and allowed more resection of the tumor. After adequate decompression of the tumor was achieved, hemostasis was controlled very easily and then the dura was closed with 4-0 Vicryl. The biopsy pieces sent was craniopharyngioma. The bone flap was then replaced and fixed with mini plates. The muscle was then closed with 2-0 Vicryl, the subcutaneous tissues with 0 Vicryl, and the skin closed with staples. A Jackson-Pratt drain was left in the subgaleal space.
