Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial
CPT4 code
Name of the Procedure:
Craniectomy, Trephination, Bone Flap Craniotomy for Excision of Meningioma, Supratentorial
Summary
This surgical procedure involves removing a portion of the skull to access and excise a meningioma, a type of brain tumor located above the tentorium cerebelli (supratentorial region). The bone flap is temporarily removed to allow the surgeon to reach and remove the tumor, and then it is replaced and secured.
Purpose
Medical Condition: The procedure addresses the presence of a meningioma, which can cause neurological symptoms due to its size and pressure on the brain. Goals: The primary goals are to completely remove the tumor, alleviate symptoms, prevent further neurological damage, and improve the patient’s quality of life.
Indications
- Persistent headaches
- Seizures
- Changes in vision or hearing
- Cognitive or personality changes
- Focal neurological deficits (e.g., weakness or numbness)
- Size and location of the tumor affecting vital brain structures
- Tumor not responding to other treatments like radiation or medication
Preparation
- Fasting: No food or drink for 8 hours before surgery.
- Medication Adjustments: Instructions on which medications to continue or stop.
- Diagnostic Tests: MRI or CT scan to map the tumor; blood tests, and pre-anesthesia evaluation.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
- Incision: A scalp incision is made over the area of the tumor.
- Bone Flap Removal: A section of the skull is removed (craniotomy) to expose the brain.
- Tumor Excision: The meningioma is carefully excised using microsurgical techniques.
- Repair: The dura (brain’s protective covering) may be repaired or reconstructed.
- Bone Flap Replacement: The bone flap is replaced and secured with small plates and screws.
- Closure: The skin is stitched or stapled closed.
Duration
Typically, the procedure takes 3-5 hours, depending on the tumor's size and complexity.
Setting
This procedure is performed in a hospital, specifically in a neurosurgical operating room.
Personnel
- Neurosurgeon
- Surgical assistants
- Anesthesiologist
- Operating room nurses
- Scrub technician
Risks and Complications
- Common Risks: Infection, bleeding, cerebrospinal fluid leak, and swelling.
- Rare Risks: Stroke, paralysis, seizures, or complications related to anesthesia.
- Management: Post-operative monitoring, antibiotics, and interventions if complications arise.
Benefits
- Removal of the tumor
- Symptom relief
- Prevention of further neurological damage
- Improved overall quality of life
- Most benefits may be realized within weeks to months post-surgery.
Recovery
- Post-Procedure Care: ICU monitoring followed by hospital stay; pain management with medications.
- Instructions: Wound care and activity limitations.
- Recovery Time: 4-6 weeks for initial recovery, with gradually increasing activities.
- Follow-up: Regular appointments for monitoring, additional imaging to ensure complete tumor removal.
Alternatives
- Radiation Therapy: Non-invasive but may have less immediate effectiveness.
- Observation: Suitable for smaller, asymptomatic meningiomas.
- Stereotactic Radiosurgery: Less invasive but not suitable for all tumor locations and sizes.
- Pros and Cons: Alternative treatments may have fewer immediate risks but are often less effective for large or symptomatic tumors compared to surgical removal.
Patient Experience
- During Procedure: Patient is under general anesthesia and will not feel anything.
- Post-Procedure Pain: Pain and discomfort managed with medications.
- Hospital Stay: Usually several days for monitoring.
- Emotional and Physical Support: Counseling and physical therapy may be recommended for recovery support.