PREOPERATIVE DIAGNOSIS: Left sphenoid wing meningioma.
POSTOPERATIVE DIAGNOSIS: Left sphenoid wing meningioma.
NAME OF OPERATION: Left frontal temporal craniotomy and removal of
meningioma involving removal of the lesser wing of sphenoid at the
ESTIMATED BLOOD LOSS: 400 cc.
INTRAOPERATIVE FLUIDS: See anesthesia record.
SPECIMENS SENT TO LAB: Tissue sent to the laboratory for analysis.
INDICATIONS FOR OPERATION: This man had presented ten days ago with
seizures and was found to have a 6 x 5 x 5 cm left sphenoid wing
meningioma. In the course of his workup he was also found to have a
suspicious hilar lung mass and an adrenal mass. The rather large
meningioma was embolized yesterday in anticipation of surgery today.
OPERATIVE FINDINGS: Soft, gray, mildly hemorrhagic tumor arising from
the mid-portion of the lesser wing of the left sphenoid bone.
DESCRIPTION OF OPERATION/PROCEDURE: Under general endotracheal
anesthesia the patient was positioned supine. The head was kept in
three point Mayfield fixator, turned to the right. Shoulder rolls
were placed under the left side. A curvilinear incision was made from
the tragus to the mid-forehead. The scalp and underlying temporalis
muscle was raised as a single unit. A frontal-temporal craniotomy was
made with two bur holes and the craniotome. The bone was saved. A subtemporal
craniectomy was performed with rongeurs and the lateral 2/3 of the lesser wing
of the sphenoid also was carefully drilled away with the underlying
dura being coagulated repeatedly in an attempt to devascularize the
tumor further. The dura was opened in a semicircular fashion and
rotated forward over the removed sphenoid wing; portions of the dura were fused
to the bone flap and were taken with the craniotomy. The microscope was
brought into place. Under microscopic magnification the tumor was
encountered in the Sylvian fissure. It was grayish, soft, hemorhagic, non-
necrotic; it really had no discernible capsule, and only occasional gliotic
planes to distinguish neoplastic from normal tissue. The tumor was removed with
ultrasonic aspirator centrally, and with suction/bipolar technique peripherally
as it was debulked. The tumor was removed
from its dural base emanating from a portion of the wing of the
sphenoid on the left. Dissection was carried superiorly, inferiorly
and then dorsally until the displaced middle cerebral artery on the
left was identified and the final feeders to the tumor were coagulated
and divided. At the conclusion of the case there was no visible tumor
left in the temporal or frontal lobes or based on the dura of the
sphenoid. Meticulous hemostasis was obtained with bipolar and
intermittent applications of Surgiflo. The dural defect was covered
with non-suturable Duragen. The bone flap was reapproximated with
Synthes titanium plate and screw set. The temporalis muscle was
reapproximated with interrupted 3-0 Vicryl sutures as well as affixed
to the scalp with a Synthes Titanium fixation device. The scalp was
then closed over a 10 French drain with 3-0 interrupted Vicryl in the
galea and surgical clips in the skin. The drain was secured with a
2-0 silk suture. The needle and sponge counts were correct.
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