Transcribed Medical Transcription Sample Reports and Examples
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Sample Type / Medical Specialty: Neurosurgery

Surgery of the nervous system, including nerves, the brain or spinal cord.

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Craniotomy - Temporal
Left temporal craniotomy and removal of brain tumor.

Craniotomy & Neuronavigation
Right frontal craniotomy with resection of right medial frontal brain tumor. Stereotactic image-guided neuronavigation and microdissection and micro-magnification for resection of brain tumor.

Cystic Suprasellar Tumor Resection
Endoscopic and microsurgical transnasal resection of cystic suprasellar tumor.

Decompressive Laminectomy
Decompressive laminectomy at T12 with bilateral facetectomies, decompression of T11 and T12 nerve roots bilaterally with posterolateral fusion supplemented with allograft bone chips and pedicle screws and rods with crosslink Synthes ClickX System.

Discectomy, Osteophytectomy, & Foraminotomy
Anterior cervical discectomy, osteophytectomy, foraminotomies, spinal cord decompression, fusion with machined allografts, Eagle titanium plate, Jackson-Pratt drain placement, and intraoperative monitoring with EMGs and SSEPs

Epidural Hematoma Evacuation
Evacuation of epidural hematoma and insertion of epidural drain. Epidural hematoma, cervical spine. Status post cervical laminectomy, C3 through C7 postop day #10. Central cord syndrome and acute quadriplegia.

Facetectomy & Foraminotomy
Bilateral C3-C4, C4-C5, C5-C6, and C6-C7 medial facetectomy and foraminotomy with technical difficulty, total laminectomy C3, C4, C5, and C6, excision of scar tissue, and repair of dural tear with Prolene 6-0 and Tisseel.

First Followup - Shunt Surgery
Patient returns for his first followup after shunt surgery.

Frameless Stereotactic Radiosurgery
CT-guided frameless stereotactic radiosurgery for the right occipital arteriovenous malformation using dynamic tracking.

Frontotemporoparietal Craniotomy
Right frontotemporoparietal craniotomy, evacuation of acute subdural hematoma. Acute subdural hematoma, right, with herniation syndrome.

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NOTE: These transcribed medical transcription sample reports and examples are provided by various users and are for reference purpose only. MTHelpLine does not certify accuracy and quality of sample reports. These transcribed medical transcription sample reports may include some uncommon or unusual formats; this would be due to the preference of the dictating physician. All names and dates have been changed (or removed) to keep confidentiality. Any resemblance of any type of name or date or place or anything else to real world is purely incidental.
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Transcribed Medical Transcription Sample Reports and Examples