CANCER & SEIZURES

After general Endotracheal Anesthesia, my hair was shaved. Foley catheter and Plexy-Pulse was placed.
A small was placed beneath my right shoulder.
Head was placed in Mayfield pin fixation.
My head was rotated to the left of the midline and elevated 20 degrees.
The head was prepped with Betadine solution and scrubbed and draped appropriately for right frontal temporal lobe
craniotomy.

The planned surgical incision was Poppen type 1 scalp flap. This was infiltrated with 20 cc of 1% Xylocaine with Epinephrine.
The anterior limb just went into the hairline just beyond the mid-pupillary region, and the posterior limb just went anteriorly
down to the zygoma.
Sharp dissection was made through the scalp down to the temporalis fascia.
Leroy scalp clips and Dandee hemostats were placed on the scalp for hemostasis.
The scalp was dissected in a subgaleal fashion and then wrapped in a moist lap and retracted with Yasargil hooks.
The temporalis muscle and fascia was incised in a similar fashion and then separated from the skull with periosteal elevator and
retracted also with Yasargil hooks.

Five bur holes were placed in the skull with one in the pterional region and another in the inferior temporal and the inferior
frontal and mid temporal parietal.
The dura was separated with a #3 Penfield. Craniotome was used to cut the scalp flap. Multiple hole were placed around the
circumference of the craniotomy through which were threaded 3-0 wire and 4-0 Nurolon tenting stitches.
The dura was opened in a cruciate fashion, and the Sylvian fissure and temporal pole was visualized.
It should be also mentioned that they did temporal craniectomy taking off additional bone with Lecksell rongeurs from the
temporal
tip which measured 4 cm posteriorly, and the balanced coagulationwas used to incise the cortex of the mid and inferior frontal
and superotemporal gyrus using a balanced bipolar coagulation.

Then dissection was longitudinal along the superior temporal gyrus. Dissection was carried through the cortex down into the
white matter, and small veins were cut with microscissors.
As they got into the anterior aspect of the temporal lobe, abnormal tumor tissue was encountered. Multiple specimens were
taken for pathology.

Frozen section was consistent with high grade anaplastic astrocytoma.

Then 4cm of the temporal lobe was resected.
Then operating microscope was brought into the field.
All bleeding was controlled with balanced bipolar coagulation.
No residual tumor could be visualized.
Surgicel was placed at the site.
The wound was irrigated copiously with Bacitracin solution and Ringer’s lactate.
Then the wound closure was 4-0 Nurolon for the dura.
Bone Flap was wired back in place using 3-0 wire.
The temporalis muscle was reattached 2-0 Vicryl.
Scalp closure was in two layers with 3-0 Vicryl for the galea and 3-0 Prolene running locked.
Dry, sterile dressing was placed.
The patient extubated and sent to the intensive care unit in satisfactory condidtion.
Estimated blood loss was 250.
Sponge and needle count were reported as correct times two.
I received 2 mg of Kefzol IV and 300 mg of Dilantin with 20 mg of Lasix and 350 cc of 20% Mannitol and 20 mg of
Dexamenthasone. Also a subgaleal Hemovac drain was placed.

I imagine the oother surgeries were the same

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