Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and elevation of frontal and/or temporal lobe(s); without orbital exenteration
CPT4 code
Name of the Procedure:
Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and elevation of frontal and/or temporal lobe(s); without orbital exenteration
Summary
This is a surgical procedure where the surgeon gains access to the anterior cranial fossa, primarily targeting areas around the frontal or temporal lobes of the brain by making an incision near the orbital ridge. The objective is to perform the surgery without removing the eye or any part of the orbital content.
Purpose
Medical Condition:
This procedure is typically indicated for:
- Removal of tumors in the anterior cranial fossa.
- Managing certain types of brain injuries or hemorrhages.
- Treating infections or lesions in the area.
Goals:
The main goals are to effectively access and treat the target area in the brain while preserving as much normal structure and function as possible.
Indications
Symptoms/Conditions:
- Persistent neurological deficits such as vision problems, seizures, or cognitive issues.
- Diagnosed brain tumors or lesions situated in the anterior cranial fossa.
- Traumatic brain injuries requiring access to the anterior cranial fossa.
Patient Criteria:
- Patients who are medically stable and can tolerate surgery.
- Patients with conditions that are not responsive to less invasive treatments.
Preparation
Pre-Procedure Instructions:
- Patients may need to fast for 8 hours before the surgery.
- Adjustments or discontinuation of certain medications, especially blood thinners.
- Pre-operative imaging studies like MRI or CT scans are typically required.
Procedure Description
Steps:
- Administration of general anesthesia.
- Incision near the supraorbital ridge.
- Osteotomy of the supraorbital ridge to gain access to the anterior cranial fossa.
- Elevation of the frontal and/or temporal lobes as needed.
- Performing the intended surgical correction or removal.
- Closure of the incision.
Tools/Equipment:
- Surgical drill for osteotomy.
- Retractors to hold back brain tissue.
- Microsurgical instruments.
Anesthesia:
General anesthesia is administered to ensure the patient is unconscious and free from pain during the procedure.
Duration
The procedure typically takes between 4 to 6 hours, depending on the complexity of the case.
Setting
The procedure is performed in a hospital setting, typically in a specialized neurosurgical suite.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses and technicians
- Possibly a neuro-ophthalmologist if eye structures are involved for monitoring
Risks and Complications
Common Risks:
- Infection
- Bleeding
- Swelling of the brain
Rare Complications:
- Damage to surrounding brain tissue.
- Vision problems if the optic nerve is affected.
- Cerebrospinal fluid leaks.
Benefits
- Direct access to anterior cranial fossa for effective treatment.
- Potential improvement in neurological function.
- Removal or reduction of tumors or lesions.
Recovery
Post-Procedure Care:
- Monitoring in an intensive care unit initially.
- Pain management.
- Gradual increase in activity.
Recovery Time:
- Hospital stay of about a week.
- Full recovery may take several weeks to months.
- Follow-up appointments for imaging and assessment.
Alternatives
Other Options:
- Radiotherapy or chemotherapy for tumors.
- Endoscopic surgery for less invasive access.
- Medical management for non-surgical candidates.
Pros and Cons:
- Less invasive options might not be as effective for certain conditions.
- Surgical options generally provide a more definitive treatment but come with higher risks.
Patient Experience
During the Procedure:
- The patient will not feel anything during the surgery due to anesthesia.
After the Procedure:
- Postoperative pain managed with medication.
- Possible sensations of swelling or headache.
- Gradual recovery with support from healthcare professionals for rehabilitation.