Brain Surgery – Operative Notes

“Incision was made slowly with the larger vessels being controlled and coagulated as we opened the scalp. Scalp flap… was wrapped in a warm saline soaked pad and fishhooks attached… to maintain this exposure…

(10:30… as my family waited patiently in the waiting room for Dr. Paysinger to finish the operation, many things they had heard the neurosurgeons say kept running through their minds)

“The plate from the previous craniotomy was removed by cutting the wires and lifting the plate out of the defect… the rotary saw was placed on the Midax Rex and remainder of the (skull bone) flap was sawed out and removed… was sent to Pathology…”

(11:30… risk of surgery greater this time due to location of tumor, scarred tissue, lengthy operation including doing away with plate from first tumor)

“After we removed totally the diseased bone the edges were waxed. The dura was lifted with a swivel hook and opened and the intradural meningioma was seen underlying cortical tissue.”

(12 o’clock. Will Mama still know us? …she might not even make it through the operation)

“We kept the cortex covered with cottonoids as we moved along and slowly dissected the tumor off of the cortex… then the tumor was removed… with dural attachments still present. The underlying cortex was very raw… with gentle saline irrigation, the cortex was irrigated…”

(12:30… tumor on “speech area” of brain will affect speech, comprehension, reading… maybe even cause paralysis… should expect 5-15% speech and/or motor problems to be permanent…)

“Dural substitution was then used to close the large dural defect that had been left. This was sutured into place covering the underlying cortex. We felt there was going to be a tremendous amount of swelling because of the large tumor that was removed, and adherence to the brain. It was elevated not to try and carry out a cranioplasty (put a plate in)—at this time for that reason. A drain was left in the epidural space and the scalp flap returned to its normal position. A large bulky dressing was loosely applied and the patient sent to RR.”