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Protocol Operation


Patient: Chernoknizhnaya Zlata, 2 y.o.

Address: 20-12, 5th Krasnoarmeyskaya str., St. Petersburg, Russia

The diagnosis before operation: glioma of chiasm and optic nerve, hypertensive syndrome. A condition after polychemotherapy courses.

The diagnosis after operation: the same.

Operation: 27.06.08: bone-plastic trepanation of a frontal bone on the right side. Subtotal removal of glioma of optic nerves, chiasm and optic tracts.

The report of operation

Position of the patient on an operational table:  lying on a back, with the head thrown back. On the edge of scalp a biauricular skin incision has been made in length 24 cm. Dermal-aponeurotic rag was cast away to eyes. With the help of hi-speed drills bony-periosteal  rag was cut out in the size of 6,0x5,0 cm and it was removed from a wound. The firm brain cover is of usual colour, strained, a brain pulsation transfers poorly, swell out into the bone defect. Dura mater of brain is dissected  in "∏" form. With the help spatula a traction of the right part of frontal lobe has been made up to 2,0 cm with an exit on chismal-cellaral area and a roof of the right orbit. At revision of dura mater of brain the pathological tissue of muddy-grey colour, in soft consistence, with an abundance of small vessels with a clear boundary is defined. The tumour shrouds supraclinoid part of internal carotid artery, a fork of anterior and medial cerebral arteries and is represented by optic nerves, chiasm, optic tracts which are thickened sharply. The tumour  is a single whole 40x40mm size. On a lateral surface the changed right optic nerve is cut throughout 1 cm, interneural removal of pathologic tissue (of a soft consistence,with plentiful blood supply, of cherry-blue colour) is performed. Removal of a tumoral tissue was performed within 75 %. Perineurium of optic nerves, chiasm and tracts are left. After tumour removal the hypophysis and its stalk is visible distinctly. The pathological tissue is handed over for  histologic research. In a removed tumour bed the drainage is left. Drainage is withdrawn through the counterpuncture. The wound was checked for hemostasis and foreign bodies. The bone is laid back on its place and fixed with periosteum. Seams are imposed on a muscle and skin. Aseptic  bandage is imposed.

Sergeon:  Snischuk V.P.

Assistant: Gusev A.A.

Operational nurse: Dinara

Anaesthesiologist: Schegolev V.I.