This is a 27-year-old male with the recurrent left S1 nerve sheath tumor. Patient had undergone a previous left L5-S1 hemilaminotomy for a cyst aspiration and partial tumor removal in February. At that time, he was given the pathologic diagnosis of ganglioneuroma. (Continued) OPERATIVE REPORT Patient Name: Robert Randall Patient Id: 110123 Date of Surgery: 08/09/2014 Page 2 Patient developed recurrent left leg symptoms including pain and weakness. This corresponded with the progressive enlargement of the cysts on ___________________ MRIs.
I explained the risk, benefits, and alternatives. All questions were answered and the patient elected to proceed with reexploration. DESCRIPTION OF OPERATION: Patient was brought to the operating room and identified by name and bracelet. General endotracheal anesthesia was administered in the supine position. Patient was then flipped into the prone position on a Jackson table with a Wilson frame. Neurophysiologic monitoring was applied to the patient. Previous incision site was then prepped and draped in the usual sterile fashion.
Then 10 mL of 1% lidocaine with 1:200,000 epinephrine was injected along the previous incision tract. The skin was sharply incised with a #10 scalpel. Both the mono cautery and a periosteal elevator were then used to dissect the subcutaneous tissue and deep muscle fascia. Spinous process was identified and the subperiosteal dissection was carried down and out the respective lamina. Fluoroscopy was then used to confirm this to be the left L5-S1 level. Self-retaining retractor was then placed into the wound. A high-speed drill was then used to increase the laminectomy defect.
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Schizophrenia, A splitting of the mind Dementia Praecox, the early term for schizophrenia was presented by Emil Kraepelin in 1898. Dementia Praecox included - dementia paranoids, catatonia and hebephrenia. Whilst these different entities are symptomatically very diverse, Kraepelin believed they shared a common core. Kraepelin noted several major symptoms in his patients, these included ...
This allowed the exposer of virgin dura. This “normal anatomy” dissection was carried back into the previous surgical site. A large cystic mass was easily identified. What appeared to be ventral to the S2 nerve root, which was confirmed with neurophysiologic monitoring, appear to be obscuring the left S1 nerve root. Repeated stimulation revealed no active S1 nerve fibrous on direct stimulation, but preservation of S1 motor function during dedicated testing. (Continued) OPERATIVE REPORT Patient Name: Robert Randall Patient Id: 110123 Date of Surgery: 08/09/2014 Page 3
This wall was open sharply and drained of fluid. Several specimens were sent for frozen section, which reveal a single cell tumor consistent with nerve sheath tumor. No further specific diagnosis was available from frozen section. Addition specimens were sent for permanent section. As much tumor wall that could be safely resected was removed. The wound was then copiously irrigated with antibiotic-containing solution. Hemostasis was then achieved with the use of bipolar cautery. Somatic sensory and motor signals were again tested and thought to be all remaining at base line functions.
The wound was then closed in layers utilizing interrupted 0 Vicryl on the deep muscle fascia. Subcutaneous tissues were closed utilizing inverted interrupted 2-0 Vicryl suture. The skin was then closed with the 3-0 Monocryl suture in a running subcuticular stitch. Dermabond was applied to the skin edges. Patient was then flipped back into the supine position on a ___________ bed. Patient was extubated in the operating room by anesthesia without incident. Prior to leaving the OR patient was awake, alert, and moving all extremities strongly. There were no complaints. Instrument and sponge count correct.
