Craniectomy, suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or without dural graft (eg, Arnold-Chiari malformation)
CPT4 code
Name of the Procedure:
Craniectomy, Suboccipital with Cervical Laminectomy for Decompression of Medulla and Spinal Cord
Common Name(s): Suboccipital Craniectomy, Cervical Laminectomy
Medical Terms: For decompression of medulla and spinal cord, with or without dural graft (e.g., Arnold-Chiari Malformation)
Summary
A craniectomy is a surgical procedure where part of the skull is removed to relieve pressure on the brain. Specifically, in this procedure, the bone at the back of the skull and cervical spine is removed to decompress the medulla and spinal cord. This is often done to treat conditions like Arnold-Chiari malformation, where part of the brain extends into the spinal canal.
Purpose
Medical Condition or Problem Addressed
- Arnold-Chiari Malformation
- Compressive myelopathy ##### Goals or Expected Outcomes
- Relieve pressure on the brainstem and spinal cord
- Restore normal flow of cerebrospinal fluid (CSF)
- Reduce neurological symptoms and prevent further damage
Indications
Symptoms or Conditions
- Severe headaches
- Neck pain
- Unsteady gait or coordination problems
- Difficulty swallowing
- Breathing difficulties ##### Patient Criteria
- Diagnosed Arnold-Chiari malformation
- Evidence of spinal cord compression on imaging studies
- Severe, disabling symptoms not responding to conservative treatments
Preparation
Pre-procedure Instructions
- Fasting for 8 hours before the surgery
- Adjusting or discontinuing certain medications under doctor’s supervision ##### Diagnostic Tests
- MRI or CT scan of the brain and cervical spine
- Preoperative blood tests and physical examination
Procedure Description
- Anesthesia: General anesthesia is administered.
- Positioning: The patient is positioned face down.
- Incision: A skin incision is made at the back of the head and upper neck.
- Craniectomy: A portion of the occipital bone is removed.
- Laminectomy: Lamina of the upper cervical vertebrae is removed.
- Decompression: Dura (outer membrane covering the brain and spinal cord) is opened; additional procedures, like thinning of the cerebellar tonsils, are performed if necessary.
- Dural Graft: If needed, a dural graft is placed to create more space for the brain tissue.
- Closure: The incision is closed with sutures or staples.
Tools and Equipment
- Surgical microscopes
- High-speed drills
- Dural graft materials
Duration
- Typically 3 to 6 hours.
Setting
- Performed in a hospital operating room.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
Common Risks
- Infection
- Bleeding
- Cerebrospinal fluid leak ##### Rare Risks
- Stroke
- Damage to brainstem or spinal cord
- Persistent neurological deficits
Benefits
- Significant reduction of symptoms
- Potential halt or reversal in disease progression
- Improved quality of life
Recovery
Post-procedure Care
- Pain management with medications
- Possible temporary ventilation support
- Monitoring in an intensive care unit (ICU) initially ##### Recovery Time
- Hospital stay for about a week
- Full recovery may take several months ##### Restrictions
- Limited physical activity for 4-6 weeks
- Follow-up appointments to monitor recovery progress
Alternatives
- Conservative management with medications and physical therapy
- Serial monitoring with imaging for non-progressive cases ##### Pros and Cons
- Conservative Management: Lower immediate risk, but may not address severe symptoms
- Serial Monitoring: Non-invasive, but may allow condition to worsen without intervention
Patient Experience
During the Procedure
- Under general anesthesia, patient will be unconscious with no awareness or pain. ##### After the Procedure
- Initial pain managed with medications
- Discomfort from the incision area ##### Pain Management
- Medications will be provided for pain relief
- Gradual transition to oral pain medications as recovery progresses