Hello,
For those that do Neuro Sx can you please look at this op note.
BRIEF HISTORY/INDICATIONS: Patient was status post decompressive hemicraniectomy on 4 months ago for treatment of malignant cerebral edema. The patient presents for autologous cranioplasty
DESCRIPTION OF OPERATION…….Using monopolar cautery, dissection was carried through the deeper planes down to the bone in a circumferential fashion following the bone on its outer edge. Using Adson forceps, the galea was elevated and using Metzenbaum scissors as well as a Penfield 1 dissection below the galea was carried out. The previous DuraGen duraplasty was not visible and the cortical ribbon was directly adherent to the galea as well as the muscular fibers and temporalis fascia. Using bipolar cautery, Metzenbaum scissors as well as the Penfield 1 a plane was created from the temporalis fascia as well as dissecting above the level of the galea to the edges of the bone. This was quite challenging given adhesion of the cortical brain at numerous portions to the galea directly. Using 0.5 x 3 cottonoids, as well as Surgicel and bipolar cautery, cortical bleeding was controlled. Once the myocutaneous flap was elevated and the temporalis muscle and fascia were split, leaving the vascularized portion on top of the brain, the edges of the craniotomy defect were fully developed using a Penfield 1. There was bony growth evident. Therefore, a Midas Rex drill and an MA drill bit were used to drill down the bone until healthy bleeding bone was noted in order to facilitate appropriate healing. Warm antibiotic irrigation was utilized and once no further bleeding points were noted, DuraGen onlay duraplasty was performed following which the autologous bone flap which was stored in Life Net was prepared on the back table using the Synthes cranial fixation system. The bone flap was then secured to the skull using the Synthes cranial fixation system and 4 mm screws
For those that do Neuro Sx can you please look at this op note.
BRIEF HISTORY/INDICATIONS: Patient was status post decompressive hemicraniectomy on 4 months ago for treatment of malignant cerebral edema. The patient presents for autologous cranioplasty
DESCRIPTION OF OPERATION…….Using monopolar cautery, dissection was carried through the deeper planes down to the bone in a circumferential fashion following the bone on its outer edge. Using Adson forceps, the galea was elevated and using Metzenbaum scissors as well as a Penfield 1 dissection below the galea was carried out. The previous DuraGen duraplasty was not visible and the cortical ribbon was directly adherent to the galea as well as the muscular fibers and temporalis fascia. Using bipolar cautery, Metzenbaum scissors as well as the Penfield 1 a plane was created from the temporalis fascia as well as dissecting above the level of the galea to the edges of the bone. This was quite challenging given adhesion of the cortical brain at numerous portions to the galea directly. Using 0.5 x 3 cottonoids, as well as Surgicel and bipolar cautery, cortical bleeding was controlled. Once the myocutaneous flap was elevated and the temporalis muscle and fascia were split, leaving the vascularized portion on top of the brain, the edges of the craniotomy defect were fully developed using a Penfield 1. There was bony growth evident. Therefore, a Midas Rex drill and an MA drill bit were used to drill down the bone until healthy bleeding bone was noted in order to facilitate appropriate healing. Warm antibiotic irrigation was utilized and once no further bleeding points were noted, DuraGen onlay duraplasty was performed following which the autologous bone flap which was stored in Life Net was prepared on the back table using the Synthes cranial fixation system. The bone flap was then secured to the skull using the Synthes cranial fixation system and 4 mm screws