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Thread: Left Sphenoid wing meningioma...HELP NEEDED

  1. #1

    Default Left Sphenoid wing meningioma...HELP NEEDED

    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
    skull base.

    ANESTHESIA: General.


    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.

    Need help 61512, 61608, 61583, 69990 ????

  2. #2


    As per the Op report we can go with CPT 61512 and 69990.

    B.Pharma, CPC-H

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