Operative Report, with Comments

Until last week, I wonder what, exactly, Dr. McDreamy meant when he said he used multiple clips in my head.  Then, I was given an “operative report”, aka a dictation from my surgeon about what he did.  I have skipped anything boring or super technical.  My comments are in italics.

This patient presented as a result of a complex middle cerebral artery aneurysm.  She was in fact called back by the Radiology Service, who had noted that she had significant blood on her CT scan (this was not at all terrifying...sarcasm.  They told me to come back to the hospital immediately, but that I didn't need to take an ambulance).......I reviewed the case with Dr. Namechangedtoprotectdoctor who felt that endovascular repair for this may not be a good option (damn it - I wanted that one.  It wouldn't have involved cracking my head open) and recommended surgical repair.  Understanding the inherent risks, including those of residual disease, stroke, neurological injury.....possibility of vasospasm and growth of the aneurysm in a delayed fashion, she wished to proceed with surgery (well it sounds a little bit dangerous when you put it that way).

.....A frontotemportal flap was marked and prepped in sterile fashion.  The incision was carried down through the skin and the subcutaneous places, and the temporalis muscle was then mobilized with no difficulty.  The differential flap was then created.  A frontotemporal craniotomy was cut with no difficulty.  Upon doing so, the dura was then identified and opened and the microscope brought into position. The neuronavigation was not used to identify the proximal sylvian fissue just proximal to the bifurcation. ....We then traveled distally....until the aneurysm could be seen.....As we traveled distally the morphology of the aneurysm became very complex (oh good)....A temporary clip was applied across the M2.  At this point, a fenestrated right angle clip was then fashioned... to occlude this portion of the aneurysm.  A small curved clip was used to augment this (three?!?). ...I was concerned that this segment may represent the actual orifice of the M2 and I did not want to compromise this for fear of giving the patient a stroke (appreciated).  Doppler was then used after the temporary clips were removed....Once we were satisfied with this, hemostasis was achieved and the patient appeared to tolerate this reasonably well hemodynamically (hells yeah I did).  We initiated our closure.

The dura was then reapproximated in a watertight fashion (I wouldn't have my dura any other way).  The bone plates were repositioned and held in place with titanium microscrews (when I bump my head, they feel like megascrews).  Overlying musculature was then closed in a multilayer fashion.  The skin was closed in a standard two fashion with a pressure dressing applied (THANK YOU McDreamy).