DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Suprasellar mass.
POSTOPERATIVE DIAGNOSIS: Suprasellar mass.
OPERATION PERFORMED: Right transorbital frontal craniotomy and removal of the suprasellar lesion.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
COMPLICATIONS: None.
SPECIMEN: Suprasellar mass.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman who presented to the hospital a few days ago with onset of acute headaches for a few days and was found to have suprasellar mass and also some spots of subarachnoid hemorrhages. The patient was investigated with cerebral angiogram and MRI, which confirmed the presence of the subarachnoid hemorrhage and also the presence of the suprasellar lesion indenting the optic nerves and the optic chiasm.
After a long discussion with the patient, we decided to proceed with biopsy of the lesion and possible removal. The patient understands the risks and benefits including, but not limited to, stroke, hematoma, reoperation, infections, blindness, and seizures. The patient signed consent to proceed with right transorbital frontal craniotomy and removal of the suprasellar lesion.
DESCRIPTION OF OPERATION: The patient was intubated and placed in the supine position. Then, a frontal temporal scalp incision was marked. It was prepped and draped in a sterile fashion. Incision was made with 10 blade scalpel and Bovie coagulator. The scalp flap was reflected anteriorly and inferiorly.
Then, using Midas Rex and after dissection of the temporalis muscle, a bur hole was made in a lateral frontal area and a small flap was turned, which included also the rim of the orbit. In this fashion, we obtained a skull base approach of the anterior fossa.
The dura was opened, and under the microscope with microdissection and with the help of a Budde retractor, the frontal lobe was gently retracted. CSF was removed, and the anterior fossa was approached. After cutting the arachnoid along the optic nerve, the carotid, and optic chiasm, the lesion was immediately found. The lesion was entered. After coagulation, it was removed in a piecemeal fashion. The pieces were sent to pathology for examination. The capsule was emptied.
Hemostasis was easily achieved. The area was abundantly irrigated with warm lactated Ringer. At the end of the surgery, the dura was closed with 4-0 Vicryl. The bone flap was replaced and affixed with a miniplate and then some of the bony defects were also covered with DBX bone source. The scalp was then closed with 2-0 Vicryl and staples.
