DATE OF Operation: 02/17/2004
PREOPERATIVE DIAGNOSES:
Right temporal intracerebral hematoma, possible Arteriovenous malformation.
POSTOPERATIVE DIAGNOSES:
Right intracerebral hematoma with arteriovenous malformation.
OPERATION PERFORMED: Right frontotemporal craniotomy and removal of
Intracerebral hematoma and arteriovenous malformation.
SURGEON; Ralph Rydell, MD
PATIENT: Eric Haase
ANESTHESIA:
DESCRIPTION OF PROCEDURE: The patient was placed on the operating room table and anesthesia was induced. The head was turned to the left so the
right side was uppermost.

The head had been shaved and the horseshoe shaped incision was outlined in the temporoparietal region' above the ear and extending anterior and posterior to this. The head was prepped and draped in the usual manner.

The incision was made along the previously mentioned horseshoe shaped curvilinear line.

The scalp flap was reflected and the temporalis muscle was incised and the temporalis muscle was reflected from the calvarium. Raney clips were used on the margins and the scalp flap and muscle were wrapped with the moist laparotomy sponge and ~sutured to it and then held backwards.

continued, next column.

A single bur hole was placed in the temporal area. The dura was separated. The Stryker craniotome was used to cut the bone flap. The bone flap was elevated and the drill holes were made about the margins of the craniotomy and the dura was tacked up to these holes with 4-0 braided nylon.

The dura was opened and hinged inferiorly. The temporal lobe and the inferior parietal lobule were thus exposed. The gyri of the temporal lobe were edematous and stretched. In the mid portion of the second temporal gyrus, this was opened and the hematoma was removed. The hematoma extended anteriorly and posteriorly and this was all removed as it was in the sylvian f issure and the substance of the temporal lobe.

The hematoma was entirely removed and there was bleeding initially from the cortical surface. This was coagulated. Beneath that, on the brain on the lateral aspect of the clot but on the temporal lobe, there was residual of apparent arteriovenous malformation. This small tangle of blood vessels was coagulated and removed and there was no further bleeding.

The area was lavaged and the blood pressure was elevated at 245 mmHg and no bleeding ensued. The area was further lavaged and the temporal lobe was now quite relaxed and pulled away from the calvarium. The dura was then closed with .O nylon. The bone flap was then secured in place with QuickFlap straps.

The temporalis muscle was resutured using O-Vicryl and the galea was closed using 3-0 Vicryl and the scalp was closed with staples… (I kept these staples after they were removed and made a maraca out of them… Tee hee… Eric.) Dressings were applied and the patient was returned to the Post anesthesia recovery room.

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