Using the navigation, a small curvilinear incision in the coronal plane in the right mid temporal region was planned, clipped, marked, prepped, infiltrated, and sterilely draped using very l
6. Code Line Three.
Procedure Performed:
1. Frameless stereotactic navigation. bundled
2. Small craniectomy in the temporal region.bundled
3. Stereotactic-guided needle biopsy of brain tumor with 3 core specimens collected.
Procedure In Detail:
Using the navigation, a small curvilinear incision in the coronal plane in the right mid temporal region was planned, clipped, marked, prepped, infiltrated, and sterilely draped using very light drapes to avoid any traction and disturbance of the navigation. We also took great care not to move the position of the operating table at all. The incision was then opened sharply and bipolar and Bovie cautery used to split the muscle down to the temporal skull at about the level of the squamosal suture. Navigation was used to confirm entry site. A small craniectomy was made with a drill. The biopsy arm was rechecked and brought into place and entry angle checked. The dura was then opened sharply and coagulated to make an entry approach and the pial surface was coagulated and opened. The trajectory was then adjusted and checked. The depth was triply checked by myself, and the navigation technologist, and had a backup check of the distance from the cortical surface to the trajectory, which was computed on the screen as we passed the needle and was also confirmed by a visual check of the 10 mm marks on the needle between the hub and the bushing as we reached the cortical surface.
I then used light suction with a side-cut needle to obtain 3 core samples, which did appear to be abnormal, consistent with low-grade glioma. These were sent with our navigation technologist and confirmed as likely low-grade glioma by the pathologist on frozen section of a portion of one of the 3 samples. All the rest of the tissue was retained for permanent section.
Meticulous hemostasis was achieved and irrigation with bacitracin was used. DuraGen was tucked under the edges of the craniectomy in order to form a closure. The temporalis fascia was closed with interrupted absorbable suture, the galea closed with interrupted absorbable suture, and the skin closed with a running absorbable suture secured with skin glue.
The patient was taken under anesthesia into the adjacent iMRI imaging room, where MR scan showed the biopsy location well within the tumor and the trajectory perfectly through the temporal stem without any complication.
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