tanisha83
Contributor
OPERATION:
1. Suboccipital craniectomy and C1 laminectomy for gross total resection of cerebellar tumor. 2. Stealth neuronavigation.
3. Microneurosurgical techniques.
4. Use of intraoperative MRI.
ANESTHESIA: General with endotracheal intubation.
INTRAVENOUS FLUIDS: Less than 200 mL crystalloid; 1 unit packed red blood cells.
ESTIMATED BLOOD LOSS: 200 mL.
INTRAOPERATIVE COMPLICATIONS: None.
POSTOPERATIVE STATUS: Stable.
FINDINGS: Brain tumor.
SPECIMENS SUBMITTED: Brain tumor - frozen and permanent pathological evaluation.
INDICATION FOR SURGERY: The above who presents with a 2-week history of worsening headaches. Workup included head CT scan which revealed a right-sided cerebellar lesion identified on the subsequent MRI. The above-mentioned was recommended.
Risks, benefits, alternatives, and expectations were fully discussed with the family. All questions answered. Consent for surgery given.
TECHNIQUE: After preoperative workup was completed and consent for surgery signed, the patient was transferred to the operating room where general endotracheal anesthesia was induced without complications. Intravenous lines secured by the personnel from the department of anesthesia. Appropriate cardiovascular monitoring lines applied. The patient was placed in a 3-point Dora radiolucent head clamp. This was done to accommodate the intraoperative MRI. While was placed, a Foley catheter was placed. Drugs given at this point included antibiotics and Decadron.
The patient was turned in the prone position for standard suboccipital craniectomy. All bony prominences and peripheral nerves were well padded. All precautions were taken for intraoperative MRI usage.
The patient was prepped and draped in strict sterile fashion.
A hockey stick incision was made to the patient's right hand side. The incision was made using a Shaw scalpel. The underlying subcutaneous tissue was divided. Antibiotic soaked sponges were attached to skin edge using Raney clips. A self-retaining retractor was placed in the wound and the ligamentum nuchae were divided down the suboccipital squame to the C1 and C2 lamina. These were exposed without issue.
We then performed a suboccipital craniectomy. This was done after mapping out the area using Stealth neuronavigation that had been registered with patient preoperatively as per protocol.
The craniotomy flap was eccentric to patient's right-hand side, across the midline. We went up to about an inch below the transverse sinus. It extended about 5 to 6 cm on the patient's right-hand side. It was removed without issue and stored for the remainder of the procedure. We then extended our craniectomy using a variety of hand held rongeurs and the Midas Rex bit.
An intraoperative ultrasound was obtained. This confirmed the location of the tumor.
We elected to approach the tumor through a cerebellar corticectomy which was done along one of the gyri. ______ along one of the cerebellar sulcus between the fovea. A halo self-retaining retractor was used intermittently during the procedure.
Using a bipolar electrocautery, we made a corectomy and dissected down to the tumor.
The tumor itself was as expected of solid, cystic, moderately vascular and distinct from the brain although the brain tumor border was not well defined.
For the next hour or two, we removed the tumor using standard microneurosurgical techniques as well as multiple specimens were sent for study, which patient and family consented to preoperatively as well as frozen and permanent pathological evaluation.
At this point, we felt that we achieved a gross total resection.
Intraoperative MRI confirmed that there was just a small rim of tumor superiorly and anteriorly and epidural to a lesser extent laterally.
We prepped and draped and scrubbed back into the field. Again, using self-retaining system, we removed the area seen on MRI, although grossly it was not obvious tumor. It appeared to be more a capsule rather tumor itself in that there was some vascularity and some fibrous tissue. Nonetheless, it was removed until we clearly were within normal gliotic although swollen brain, specifically cerebellar white matter.
After obtaining meticulous hemostasis, the field was lined using Surgicel.
A watertight dural closure was achieved closure was achieved primarily using 4-0 Nurolon tackup sutures.
A few epidural tack-up sutures were placed as well.
After covering the area, we used a piece of dry Gelfoam. This was in turn covered with Tisseel.
I would like to mention that a C1 laminectomy was performed at opening. Note that there was no compression of the dura whatsoever. The bone flap was resecured using titanium plates and screws. A good construct was achieved.
After irrigating the wound, closure was achieved using inverted interrupted 2-0 Vicryl sutures and 3-0 Vicryl sutures and 4-0 Vicryl sutures in the deep and superficial musculature and subcutaneous tissue respectively. A 4-0 black monofilament nylon suture was used to reapproximate the skin edges.
The patient tolerated the procedure well.
1. Suboccipital craniectomy and C1 laminectomy for gross total resection of cerebellar tumor. 2. Stealth neuronavigation.
3. Microneurosurgical techniques.
4. Use of intraoperative MRI.
ANESTHESIA: General with endotracheal intubation.
INTRAVENOUS FLUIDS: Less than 200 mL crystalloid; 1 unit packed red blood cells.
ESTIMATED BLOOD LOSS: 200 mL.
INTRAOPERATIVE COMPLICATIONS: None.
POSTOPERATIVE STATUS: Stable.
FINDINGS: Brain tumor.
SPECIMENS SUBMITTED: Brain tumor - frozen and permanent pathological evaluation.
INDICATION FOR SURGERY: The above who presents with a 2-week history of worsening headaches. Workup included head CT scan which revealed a right-sided cerebellar lesion identified on the subsequent MRI. The above-mentioned was recommended.
Risks, benefits, alternatives, and expectations were fully discussed with the family. All questions answered. Consent for surgery given.
TECHNIQUE: After preoperative workup was completed and consent for surgery signed, the patient was transferred to the operating room where general endotracheal anesthesia was induced without complications. Intravenous lines secured by the personnel from the department of anesthesia. Appropriate cardiovascular monitoring lines applied. The patient was placed in a 3-point Dora radiolucent head clamp. This was done to accommodate the intraoperative MRI. While was placed, a Foley catheter was placed. Drugs given at this point included antibiotics and Decadron.
The patient was turned in the prone position for standard suboccipital craniectomy. All bony prominences and peripheral nerves were well padded. All precautions were taken for intraoperative MRI usage.
The patient was prepped and draped in strict sterile fashion.
A hockey stick incision was made to the patient's right hand side. The incision was made using a Shaw scalpel. The underlying subcutaneous tissue was divided. Antibiotic soaked sponges were attached to skin edge using Raney clips. A self-retaining retractor was placed in the wound and the ligamentum nuchae were divided down the suboccipital squame to the C1 and C2 lamina. These were exposed without issue.
We then performed a suboccipital craniectomy. This was done after mapping out the area using Stealth neuronavigation that had been registered with patient preoperatively as per protocol.
The craniotomy flap was eccentric to patient's right-hand side, across the midline. We went up to about an inch below the transverse sinus. It extended about 5 to 6 cm on the patient's right-hand side. It was removed without issue and stored for the remainder of the procedure. We then extended our craniectomy using a variety of hand held rongeurs and the Midas Rex bit.
An intraoperative ultrasound was obtained. This confirmed the location of the tumor.
We elected to approach the tumor through a cerebellar corticectomy which was done along one of the gyri. ______ along one of the cerebellar sulcus between the fovea. A halo self-retaining retractor was used intermittently during the procedure.
Using a bipolar electrocautery, we made a corectomy and dissected down to the tumor.
The tumor itself was as expected of solid, cystic, moderately vascular and distinct from the brain although the brain tumor border was not well defined.
For the next hour or two, we removed the tumor using standard microneurosurgical techniques as well as multiple specimens were sent for study, which patient and family consented to preoperatively as well as frozen and permanent pathological evaluation.
At this point, we felt that we achieved a gross total resection.
Intraoperative MRI confirmed that there was just a small rim of tumor superiorly and anteriorly and epidural to a lesser extent laterally.
We prepped and draped and scrubbed back into the field. Again, using self-retaining system, we removed the area seen on MRI, although grossly it was not obvious tumor. It appeared to be more a capsule rather tumor itself in that there was some vascularity and some fibrous tissue. Nonetheless, it was removed until we clearly were within normal gliotic although swollen brain, specifically cerebellar white matter.
After obtaining meticulous hemostasis, the field was lined using Surgicel.
A watertight dural closure was achieved closure was achieved primarily using 4-0 Nurolon tackup sutures.
A few epidural tack-up sutures were placed as well.
After covering the area, we used a piece of dry Gelfoam. This was in turn covered with Tisseel.
I would like to mention that a C1 laminectomy was performed at opening. Note that there was no compression of the dura whatsoever. The bone flap was resecured using titanium plates and screws. A good construct was achieved.
After irrigating the wound, closure was achieved using inverted interrupted 2-0 Vicryl sutures and 3-0 Vicryl sutures and 4-0 Vicryl sutures in the deep and superficial musculature and subcutaneous tissue respectively. A 4-0 black monofilament nylon suture was used to reapproximate the skin edges.
The patient tolerated the procedure well.