Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial
CPT4 code
Name of the Procedure:
Subdural Tap through Fontanelle, or Suture, Infant, Unilateral or Bilateral; Initial
Summary
A subdural tap is a medical procedure performed on infants to remove excess fluid from the subdural space - the area between the brain and the skull. This procedure is typically done through a soft spot on the baby's head (fontanelle) or a suture line.
Purpose
The procedure addresses the accumulation of fluid in the subdural space, which may result from conditions like head trauma, certain types of infections, or bleeding disorders. It aims to relieve pressure on the brain, reduce intracranial pressure, and prevent potential brain damage.
Indications
- Signs of increased intracranial pressure (e.g., bulging fontanelle, irritability, vomiting)
- Diagnosed subdural hematoma or effusion
- Symptoms of neurological impairment
- Infants with head trauma or suspected brain injury
Preparation
- Parents or guardians may be advised to withhold feeding for a few hours before the procedure if general anesthesia is planned.
- Diagnostic imaging like an ultrasound or CT scan may be conducted to assess the extent of fluid accumulation.
- Complete medical history and physical examination of the infant.
Procedure Description
- The infant is positioned appropriately, usually lying down.
- Local anesthesia is administered to numb the area around the fontanelle or suture.
- A sterile needle or cannula is carefully inserted into the subdural space.
- Fluid is aspirated slowly to avoid rapid changes in intracranial pressure.
- The needle is removed, and the site is bandaged.
Tools: Sterile needle/cannula, syringes, antiseptic solutions. Anesthesia: Local anesthesia; sedation may be used in some cases.
Duration
The procedure generally takes about 15-30 minutes.
Setting
The procedure is usually performed in a hospital setting, either in a neonatal intensive care unit (NICU) or a dedicated procedure room.
Personnel
- Pediatric neurosurgeon or pediatrician
- Nurses
- Anesthesiologist (if sedation is used)
Risks and Complications
- Infection at the puncture site
- Bleeding or hematoma formation
- Brain tissue damage (rare)
- Continued fluid leakage
- Reaccumulation of fluid
Benefits
- Alleviation of symptoms related to increased intracranial pressure
- Prevention of further brain injury
- Rapid improvement in neurological function
Recovery
- Close monitoring of the infant for several hours post-procedure
- Instructions for parents on signs of complications to watch for, such as fever or increased irritability
- Follow-up appointments to monitor the infant’s condition
- Most infants recover quickly with minimal discomfort.
Alternatives
- Observation and monitoring if the fluid accumulation is small and not causing symptoms
- Surgical procedures such as subdural drains or shunts in more severe cases
- The choice of alternative depends on the severity of symptoms and overall health of the infant.
Patient Experience
During the procedure: The infant may feel minimal discomfort due to the local anesthesia. After the procedure: The baby might be fussy or irritable but typically experiences relief from symptoms of increased pressure. Pain management includes gentle handling and possibly over-the-counter analgesics as recommended by a pediatrician.