Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural
CPT4 code
Name of the Procedure:
Resection or Excision of Neoplastic, Vascular, or Infectious Lesion of Base of Anterior Cranial Fossa; Extradural
Summary
This procedure involves surgically removing abnormal growths or lesions, such as tumors, vascular malformations, or infections, located at the base of the front part of the skull just above the nasal cavity. The surgery is performed outside the dura mater, the outermost membrane covering the brain.
Purpose
This procedure addresses conditions that cause abnormal tissue growth or destructive processes such as tumors, vascular anomalies, or infections at the base of the anterior cranial fossa. The primary goal is to remove the lesion to alleviate symptoms, prevent further complications, or improve neurological function and overall health.
Indications
- Presence of a detectable tumor or neoplastic lesion
- Vascular malformations such as arteriovenous malformations (AVMs)
- Infections that have resulted in abscesses or other complications
- Symptoms like persistent headaches, vision problems, or neurological deficits
- Imaging studies (e.g., MRI or CT scans) showing lesions that affect the base of the anterior cranial fossa
Preparation
- Fasting typically required 8 hours before the procedure
- Adjustment or cessation of certain medications as directed by the doctor
- Pre-operative imaging studies (such as MRI or CT scans) to map out the lesion
- Blood tests and other routine pre-surgical assessments
- Meeting with anesthesiologist to discuss anesthesia plan
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
- Positioning: The patient is positioned optimally based on the location of the lesion.
- Incision: A scalp incision is made, and the underlying bone is exposed.
- Craniotomy: A section of the skull is removed to access the anterior cranial fossa.
- Extradural Approach: The dura mater is not opened; the surgeon works around it to reach the lesion.
- Lesion Removal: The abnormal growth or lesion is carefully excised using microsurgical tools.
- Closure: The bone flap is replaced, and the incision is closed with sutures or staples.
- Recovery: The patient is taken to recovery for monitoring.
Tools and technology used:
- Microsurgical instruments
- High-powered operating microscope
- Image-guidance systems
Duration
The procedure typically lasts between 3 to 6 hours, depending on the complexity and size of the lesion.
Setting
The surgery is performed in a hospital operating room equipped with advanced neurosurgical tools and technology.
Personnel
- Neurosurgeon
- Surgical Nurses
- Anesthesiologist
- Operating Room Technician
Risks and Complications
- Infection
- Bleeding
- Cerebral spinal fluid leak
- Neurological deficits (e.g., weakness, sensory loss, speech difficulties)
- Reaction to anesthesia
- Postoperative headaches or seizures
- Long-term complications like changes in cognitive function
Benefits
- Removal of the lesion which may alleviate symptoms and prevent further neurological damage
- Potential improvement in neurological function and quality of life
- Reduction in risk of further complications from the lesion
Recovery
- Initial recovery includes close monitoring in the ICU or a recovery room for a few days
- Pain management with medications
- Gradual return to normal activities over several weeks, typically a few months for full recovery
- Follow-up appointments to monitor healing and assess for potential complications
- Physical therapy or rehabilitation may be required based on the patient's condition
Alternatives
- Radiation therapy, especially for inoperable tumors or residual lesions
- Chemotherapy for certain types of tumors
- Conservative management with monitoring for slow-growing or asymptomatic lesions
- Endoscopic surgery for accessible lesions via the nasal passages
Patient Experience
- Patients will be under general anesthesia during the procedure and will not feel anything.
- Post-operative pain is managed with medications.
- Possible feeling of fatigue, headache, or discomfort during the initial recovery period.
- Close follow-up and support from the healthcare team to ensure a comfortable and successful recovery.