Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure)
CPT4 code
Name of the Procedure:
Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure)
Summary
This procedure involves placing a specialized device on the patient's skull to precisely locate and stabilize structures within the brain. These devices are used for navigation guidance during neurosurgery or for specific treatments like radiation therapy, to ensure accuracy. After the procedure, the device is safely removed.
Purpose
The main purpose is to stabilize and accurately target areas within the brain for surgical intervention or treatment. This ensures precise localization, minimizing damage to surrounding brain tissue and improving overall surgical outcomes.
Indications
- Intracranial tumors needing precise localizations, such as for biopsy or excision
- Stereotactic radiosurgery for conditions like arteriovenous malformations (AVMs) or small brain tumors
- Deep brain stimulation (DBS) for movement disorders
- Certain diagnostic imaging procedures requiring exact brain mapping for subsequent treatments
Preparation
- Patients may need to fast for several hours before the procedure.
- Adjustments to medications, especially blood thinners, as advised by the healthcare provider.
- Pre-procedure imaging tests such as MRI or CT scans to plan the placement.
- Detailed neurological assessments.
Procedure Description
- Anesthesia: Depending on the procedure type, local or general anesthesia may be administered.
- Positioning: The patient is positioned to allow optimal access and comfort.
- Device Placement: The cranial tongs, caliper, or stereotactic frame is precisely affixed to the patient's skull using pins or screws to ensure rigid fixation.
- Verification: Imaging techniques such as fluoroscopy, MRI, or CT scans are used to verify the correct placement and alignment.
- Procedure Execution: The main surgical or treatment procedure is carried out with the aid of the stabilized frame for accurate targeting.
- Removal: After the completion of the primary procedure, the cranial device is carefully removed.
Duration
The entire process, including anesthesia and device placement, can take between 1 to 3 hours depending on the complexity of the primary surgical or treatment procedure.
Setting
The procedure is typically performed in a hospital operating room or a specialized neurosurgical center equipped with the necessary imaging and surgical technology.
Personnel
- Neurosurgeon
- Surgical nurse
- Anesthesiologist
- Radiologic technologist (for imaging guidance)
Risks and Complications
- Infection at pin or screw sites
- Bleeding or hematoma
- Pain or discomfort at pin insertion sites
- Potential damage to the skull or brain (rare)
- Complications associated with anesthesia
Benefits
- Improved surgical accuracy and outcomes
- Minimization of damage to surrounding brain tissue
- Enhanced ability to treat conditions precisely
- Quicker post-operative recovery and fewer side effects due to targeted intervention
Recovery
- Post-procedure monitoring for any immediate complications.
- Pain management at pin or screw insertion sites.
- Limited physical activity for a few days.
- Follow-up appointments for surgical wound care and progress assessment.
- Most patients can return to normal activities within a week with minimal restrictions.
Alternatives
- Non-stereotactic surgical approaches, which are generally less precise.
- Advanced imaging-only guidance systems that may be less accurate than physical stabilization.
- Utilizing minimally invasive procedures if applicable.
Patient Experience
- Patients may feel initial pressure discomfort when the device is attached but anesthesia is used to manage this.
- Post-procedure, there might be mild pain at the pin sites, managed with medications.
- Patients can expect a detailed briefing on procedure stages, and healthcare staff will ensure their comfort throughout the process.