I am feeling like it should be
61512-22

due to the fact that 61512 cannot be reported w 50 mod

Do you agree?

OPERATION: Bilateral frontal craniotomy and resection of bifrontal parasagittal meningioma,
Stealth frameless stereotactic computer guided navigation for intradural tumor resection, microscopic
dissection.

DETAILS OF THE OPERATION: After induction of general endotracheal anesthesia, the patient was
placed in a Mayfield headholder and positioned with his head was kept neutral and his head of bed
elevated. The patient’s head was secured to the operative table. The
Stealth navigation was registered, the incision was planned using Stealth. The entire area
was prepped and draped in the usual sterile fashion. The patient received IV antibiotics,
IV mannitol, IV Decadron and IV Keppra, preoperatively and prophylactically. A bicoronal incision
was made posterior to the parasagittal meningiomas. Scalp clips were applied. The scalp was
reflected anteriorly.
The old crainiotomy sites were identified. Some of the cranial plates were removed. Right and left
craniotomies were performed encompassing the old craniotomy. Right frontal and left frontal burr
holes were made with the acorn bit on the midas rex drill. Right and left craniotomies were made
with the B1 foot plate on the midas rex drill. The right and left crainiotomies were then connected
by using the midas rex drill with a B1 foot plate to cross the sagittal sinus. The bone flaps were
elevated. The MRI was reviewed with Dr. Dougherty and we determined that the sagittal sinus was
evaded by the tumor and was occluded. There was essentially no dura covering of the brain, the
skull was inspected and any soft tissue attachments of the skull were drilled off with an acorn bit on
the Midas Rex drill. The bilateral meningiomas were identified and cottonoids were placed around
the right parasagittal meningioma which was then debulked using CUSA, bipolar cautery and suction.
Bleeding was controlled. The brain was protected. The occluded sagittal sinus was divided using
weck clips and suture and the left portion of the parasagittal meningioma was identified. Stealth
frameless stereotactic navigation was used for intradural navigation and tumor resection to minimize
brain retraction. Microscopic dissection techniques were used for tumor dissection from the cortex.
The falx was cut beneath the tumor utilizing an approach from both the right and the left
craniotomies and the tumor was elevated and then removed en bloc with the occluded sagittal sinus.
Exposed brain was covered with Surgicel. Hemostasis was achieved with bipolar cautery and
thrombin gel mix. The initial plan was to do a right parasagittal tumor debulking however, the
bleeding vessels were coming from the falx and this necessitated resection of that region of the
tumor which included the falx on the left parasagittal tumor. The entire area was irrigated with saline
solution. Hemostasiswas confirmed. The dural defect was covered with DuraGen. Gelfoam was
placed over the DuraGen. The craniotomy flaps were reconstructed with cranial plates and secured
into position with cranial plates. A 7 mm flat JP drain was tunneled subcutaneously and connected to
bulb suction. The scalp was closed in layers. The incision was covered with a dry sterile dressing.
The patient was taken out of
Mayfield head holder, awakened, and taken to the PACU in stable condition. Patricia Vieth,
P.A. assisted with skin incision, right and left craniotomies, resection of meningiomas, brain