61616 Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or C1-C3 vertebral bodies; intradural, including dural repair, with or without graft

Name of the Procedure:

Resection or Excision of Neoplastic, Vascular or Infectious Lesion of the Base of the Posterior Cranial Fossa, Jugular Foramen, Foramen Magnum, or C1-C3 Vertebral Bodies; Intradural, Including Dural Repair, With or Without Graft

Summary

This procedure involves the surgical removal of abnormal growths or lesions located at the base of the posterior cranial fossa, the jugular foramen, the foramen magnum, or the first three cervical vertebrae (C1-C3). The surgery is performed intradurally, meaning within the protective covering of the brain and spinal cord, and may include repair of the dura (the outer membrane) using a graft if necessary.

Purpose

This surgery is performed to remove neoplastic (tumor-related), vascular (blood vessel-related), or infectious lesions that can cause serious neurological symptoms, discomfort, or life-threatening complications. The goal is to relieve symptoms, prevent further neurological damage, and improve the patient's quality of life.

Indications

This procedure is indicated for:

• Patients with confirmed neoplastic, vascular, or infectious lesions in the specified areas.
• Symptoms such as severe headaches, neurological deficits (e.g., weakness, numbness), or cranial nerve dysfunction.
• Lesions that are causing spinal cord compression or other critical complications.
• Patients whose condition has not responded to other treatments.

Preparation

Patients may be instructed to:

• Fast for a specific period (usually 8-12 hours) before surgery.
• Adjust or stop certain medications, as advised by their physician.
• Undergo pre-operative imaging studies (e.g., MRI, CT scans) and blood tests.
• Have a thorough pre-operative assessment including a neurological exam.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made at the appropriate site to access the lesion.
3. The surgeon carefully exposes the dura and opens it to access the intradural space.
4. The lesion is identified and meticulously removed.
5. If necessary, the dura is repaired with sutures and possibly reinforced with a graft.
6. The surgical site is closed with sutures or staples, and a sterile dressing is applied.

Specialized surgical tools and microscopes/endoscopes may be used to enhance precision. Neuronavigation technology may also aid in accurately locating the lesion.

Duration

The procedure typically takes between 4 to 8 hours, depending on the complexity and location of the lesion.

Setting

This surgery is performed in a hospital, specifically in an operating room equipped for neurosurgical procedures.

Personnel

The surgical team usually includes:

• A neurosurgeon as the primary surgeon
• An anesthesiologist
• Surgical nurses and scrub techs
• Possibly a neurophysiologist for intraoperative monitoring

Risks and Complications

Common risks:

• Infection
• Bleeding
• Cerebrospinal fluid leak

Rare risks:

• Neurological deficits
• Blood clots
• Complications related to grafting (if used)

Complications are managed promptly with appropriate medical or surgical interventions.

Benefits

• Relief from symptoms, such as pain and neurological deficits.
• Prevention of further neurological deterioration.
• Improved quality of life and functionality.

Benefits may be realized immediately but can continue to improve over several weeks to months.

Recovery

Post-procedure care includes:

• Pain management using medications.
• Monitoring in an intensive care unit (ICU) initially.
• Gradual mobilization and physical therapy.
• Avoiding strenuous activities for a specified period.
• Follow-up appointments for wound inspection and possibly imaging studies.

Expected recovery time ranges from a few weeks to several months, depending on individual circumstances.

Alternatives

Other treatment options may include:

• Stereotactic radiosurgery (less invasive but not suitable for all lesions)
• Observation with regular monitoring (for slow-growing or benign lesions)
• Medical management for infection or symptom relief

Each alternative has its pros and cons, including varying efficacy, risks, and recovery times compared to surgical resection.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperatively, there may be discomfort or pain at the incision site, which is managed with medications. Patients might experience some temporary neurological symptoms, swelling, or fatigue, which typically improve with time and rehabilitation.