Craniectomy; for osteomyelitis
CPT4 code
Name of the Procedure:
Craniectomy for Osteomyelitis
Common name(s): Bone infection surgery, Skull infection surgery
Medical terms: Craniectomy, Osteomyelitis debridement
Summary
A craniectomy for osteomyelitis is a surgical procedure where a portion of the skull is removed to treat a severe infection of the bone tissue known as osteomyelitis. This allows access to the infected area for cleaning and treatment.
Purpose
Addresses: Severe osteomyelitis of the skull
Goals/Outcomes: Remove infected bone, treat the infection, prevent the spread of infection, and preserve as much healthy bone and tissue as possible.
Indications
Symptoms/Conditions: Persistent pain, swelling, fever, drainage from the skull, and evidence of bone infection seen in imaging studies.
Patient Criteria: Patients with confirmed osteomyelitis of the skull that is not responsive to antibiotics or other less invasive treatments.
Preparation
Pre-Procedure Instructions: Fasting for a specific period before surgery (usually 8-12 hours), stopping certain medications as advised by the healthcare provider, arranging transportation for post-procedure.
Diagnostic Tests: Blood tests, MRI or CT scans to assess the extent of the infection, pre-surgical evaluations.
Procedure Description
Steps Involved:
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
- Incision: A scalp incision is made over the infected area.
- Bone Removal: A segment of the skull bone (craniectomy) is carefully removed to expose the infected area.
- Debridement: The infected bone and surrounding tissue are meticulously cleaned and debrided.
- Infection Control: Antimicrobial agents are applied locally, and cultures may be taken to guide antibiotic treatment.
- Closure: The scalp is closed with sutures or staples, and the removed bone piece may be preserved for possible reinsertion once the infection is controlled.
Tools/Equipment: Surgical scalpels, retractors, bone saws, antimicrobial agents.
Anesthesia: General anesthesia.
Duration
Time: The procedure typically lasts 2-4 hours, depending on the extent of the infection and complexity of the case.
Setting
Location: Hospital operating room.
Personnel
Involved Professionals: Neurosurgeon, surgical nurses, anesthesiologist, and possibly an infectious disease specialist.
Risks and Complications
Common Risks: Bleeding, infection, reaction to anesthesia. Rare Risks: Brain injury, prolonged recovery, persistent infection, need for additional surgeries.
Benefits
Benefits: Effective removal of the infection, prevention of further complications, improvement of symptoms, and overall health. Benefits are usually noticeable within a few weeks post-surgery.
Recovery
Post-Procedure Care: Hospital stay for a few days, antibiotic therapy, pain management, wound care.
Recovery Time: Several weeks to months, depending on the severity of the infection and overall health.
Restrictions/Follow-Up: Avoid heavy lifting, follow-up appointments for monitoring healing, and imaging studies to assess progress.
Alternatives
Other Options: Antibiotic therapy alone (may not be effective for severe cases), hyperbaric oxygen therapy, minimally invasive debridement techniques.
Pros/Cons of Alternatives: Non-surgical methods might have lower risk but may not be sufficient to eradicate the infection entirely.
Patient Experience
During Procedure: Under general anesthesia, patient will be unconscious and feel no pain.
After Procedure: Initial discomfort, pain managed with medication, some swelling, and possible drainage. Gradual improvement over several weeks with proper wound care and antibiotic treatment. Anxiety and discomfort can be managed through effective communication and support from the healthcare team.