2013/10/25

Case 1: The Surgical Record


This patient is a sixty-year-old man who presented with a two-month history of right hand paresis and mild aphasia. The MR images show a ring-like enhanced tumor in the left frontal lobe. The tumor is well demarcated and accompanied with edema. The tumor is located adjacent to the primary motor area. High-grade glioma was most suspected based on the preoperative examinations.
The operation was performed under a general anesthesia. The patient was laid in a supine position. His head was rotated fifteen degrees to the right and fixed with a three-point fixator.
We made an arc-shaped skin incision as shown in Figure 1. Then we made a craniotomy in due form. The brain surface was normal and slightly expanded. We identified the central sulcus using the monitoring and the neuro-navigation system. A 2 cm corticotomy was made on the middle frontal gyrus shown in Figure 2. The tumor was well recognized and resected en bloc. The monitoring system did not show any abnormal findings during the surgery.
The tumor was sent to the pathology section. The rapid diagnosis was glioblastoma.
We confirmed that there was no residual tumor and no blood oozing from the resected cavity wall. Then we sutured the dura mater and fixed the bone flap with fixators. The skin was sutured with two layers. There were no problems during the operation. He didn't receive a blood transfusion.

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