20664 Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (eg, pediatric patients, hydrocephalus, osteogenesis imperfecta)

Name of the Procedure:

Application of Halo with Removal, Cranial, 6 or More Pins for Thin Skull Osteology (Pediatric Patients, Hydrocephalus, Osteogenesis Imperfecta)

Summary

This procedure involves placing a halo device on the skull using six or more pins for patients with thin skull conditions such as hydrocephalus or osteogenesis imperfecta. The halo provides head and neck stabilization. Removal of the halo is performed when it is no longer needed.

Purpose

Medical Condition:

• Hydrocephalus
• Osteogenesis imperfecta
• Other conditions leading to thin skull osteology (e.g., pediatric patients)

Goals/Outcomes:

• Stabilization of the head and neck
• Protection of the skull and cervical spine during healing or growth

Indications

• Symptoms: Instability, acute neck pain, deformities due to thin skull
• Conditions: Diagnosed hydrocephalus, osteogenesis imperfecta, etc.
• Patient Criteria: Pediatric patients or those with conditions causing thin skull bones

Preparation

• Fasting: Usually not required but follow specific instructions
• Medication: Adjustment of any blood thinners or medications as advised by the doctor
• Diagnostic Tests: Imaging studies (X-ray, MRI) to assess skull condition

Procedure Description

1. Positioning: Patient is positioned on the operating table, typically under general anesthesia.
2. Preparation: Skull is cleaned and prepped to reduce infection risk.
3. Halo Placement:
   • Halo ring is positioned around the head.
   • Six or more pins are carefully inserted into the skull to secure the halo, ensuring the stability crucial for thin skulls.
4. Validation: Proper placement confirmed with imaging.
5. Ongoing Care: Halo remains in place for an extended period, monitored regularly.
6. Removal: Upon healing, the halo and pins are carefully removed.

Duration

Approximately 1-2 hours for initial application; removal takes less time.

Setting

Typically performed in a hospital operating room.

Personnel

• Surgeons (Pediatric or Neurosurgeon)
• Nurses
• Anesthesiologists

Risks and Complications

• Infection at pin sites
• Pin misplacement (rare but more critical in thin skulls)
• Nerve or vascular injury
• Discomfort or pain at pin sites

Benefits

• Stabilizes the head and neck
• Reduces further injury risks
• Aids in proper alignment and healing

Recovery

• Post-procedure care: Regular cleaning of pin sites, follow-up imaging
• Recovery time: Varies, typically weeks to months
• Restrictions: Limited neck movement, activity restrictions as advised
• Follow-up: Regular appointments for monitoring

Alternatives

• Cervical spine fusion (more invasive)
• Soft collar or other support devices (less stabilization)

Patient Experience

• During the Procedure: Under anesthesia; no pain felt.
• After the Procedure: Possible discomfort at pin sites managed with pain medications.
• Long-term use: Adjustment period, some restrictions in activities.
• Pain Management: Over-the-counter pain relief or prescribed medication as needed.

Overall, the halo application and removal is a critical procedure offering significant stabilization benefits for patients with thin skull conditions, ensuring safer recovery and alignment.