61735 Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; subcortical structure(s) other than globus pallidus or thalamus

Name of the Procedure:

Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; subcortical structure(s) other than globus pallidus or thalamus.

Summary

In layman's terms, this procedure involves creating a small, targeted lesion in a specific part of the brain using a precise, computer-guided technique. It includes drilling small holes in the skull (burr holes) and using advanced imaging to accurately locate and treat the area of the brain that is causing symptoms.

Purpose

Medical Condition:

• Certain movement disorders (e.g., dystonia, tremors), certain types of epilepsy, and intractable pain. ##### Goals:
• To alleviate symptoms, improve quality of life, and sometimes to reduce dependency on medications.

Indications

Symptoms and Conditions:

• Severe, treatment-resistant movement disorders like dystonia and tremors.
• Specific types of chronic pain.
• Certain epilepsy cases where seizures cannot be controlled by medication. ##### Patient Criteria:
• Patients with conditions not responding to other treatments.
• Patients in good overall health and able to undergo surgery.

Preparation

• Fasting several hours before the procedure (as directed by your healthcare provider).
• Stopping certain medications as prescribed.
• Pre-procedure imaging studies such as MRI or CT scans to identify exact targets in the brain.

Procedure Description

1. Preparation: Patient is given local anesthesia and made comfortable.
2. Imaging: Advanced imaging techniques are used to precisely locate the area of the brain to be treated.
3. Burr Holes: Small holes are drilled into the skull to allow access.
4. Recording: Electrodes may be used to map brain activity and confirm target locations.
5. Lesion Creation: A lesion is created using a specialized probe or laser guided by the stereotactic system.
6. Verification: Post-procedure imaging to verify accuracy. ##### Tools:
   • Stereotactic frame or image guidance system.
   • MRI/CT scanner and electrodes. ##### Anesthesia:
   • Local anesthesia for burr holes.
   • Sedation as needed, depending on patient and procedure extent.

Duration

• Typically takes several hours, depending on the complexity.

Setting

• Usually performed in a hospital operating room with access to advanced imaging technology.

Personnel

• Neurosurgeon.
• Anesthesiologist.
• Surgical nurse.
• Radiologist (for imaging guidance).

Risks and Complications

Common Risks:

• Infection at the burr hole site.
• Bleeding in the brain.
• Swelling or inflammation. ##### Rare Risks:
• Neurological deficits.
• Seizures. ##### Management:
• Antibiotics for infection, monitoring, and supportive care for other complications.

Benefits

• Reduction or elimination of symptoms.
• Improved quality of life.
• Reduced reliance on medications.

Recovery

• Monitoring in the hospital for signs of complications.
• Pain management and antibiotics.
• Gradual return to normal activities over several weeks.
• Follow-up appointments for monitoring and possible adjustment of treatment plan.

Alternatives

Other Treatments:

• Medications, physical therapy.
• Deep brain stimulation (DBS). ##### Comparison:
• Medications may not be as effective or sustainable.
• DBS is less invasive but involves an implanted device.

Patient Experience

During Procedure:

• Minimal discomfort due to local anesthesia; patient may be awake for parts of procedure. ##### After Procedure:
• Some soreness at the burr hole site.
• Gradual symptom improvement.
• Instructions on activity restrictions and follow-up care.