DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Posterior fossa meningioma attached to the tentorium.
POSTOPERATIVE DIAGNOSIS: Posterior fossa meningioma attached to the tentorium.
PROCEDURE PERFORMED: Resection of posterior fossa meningioma.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
COMPLICATIONS: No complications.
SPECIMEN: Meningioma.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old lady who sought medical attention because of dizziness, balance problems, and headaches. She was found to have a 2.5 cm meningioma coming from the tentorium and was referred for evaluation. After a long discussion with the patient and also medical clearance, decision was made to proceed with resection of the tumor. The patient, the family, and we discussed all the options before surgery, including observation, radiation, and surgery. The patient wanted to proceed with resection and consent was signed. She understands the risks of the surgery including, but not limited to, bleeding, brain swelling, hematoma, reoperation, resection, dizziness, balance problems, and strokes. The patient signed the consent.
DESCRIPTION OF PROCEDURE: The patient was intubated and placed on a park-bench position with the right side up. An incision was marked in the midline and was prepped and draped in the sterile fashion. The incision was made with a 10 blade scalpel, Bovie coagulators, and then the midline was progressively dissected until the spinous process of C1 and C2 were identified.
Then, the suboccipital area was dissected free, and the paraspinal muscles were divided and a cuff of muscle was left on the suboccipital area for watertight closure. The Midas-Rex was used to shape a bilateral suboccipital craniotomy, and the Midas also was used to drill off the top part of the craniotomy, so that the transverse sinus bilaterally was identified and seen.
Then, the dura was opened in a Y-shaped fashion and it was tacked up. The meningioma appeared to be attached to the tentorium and invasive of the straight sinus. The tumor was resected in a piecemeal fashion, dura was extensively coagulated, and the sinus was packed with DuraGen and Tisseel.
At the end of the surgery, the resection appeared complete with the exception of the tumor still into the straight sinus, and hemostasis was achieved. The dura was closed with 4-0 Nurolon and reinforced with Tisseel. The muscle was closed with 2-0 Vicryl, 3-0 Vicryl, and 3-0 nylon for the skin.
