Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Stereotactic Computer-Assisted (Navigational) Procedure; Cranial, Intradural
Summary
This advanced procedure helps neurosurgeons accurately locate and treat specific areas within the brain. Using sophisticated imaging and computer technology, the surgeon can target and navigate precise regions inside the skull without extensive surgical exposure.
Purpose
Stereotactic computer-assisted techniques are used to address various intracranial conditions such as tumors, blood vessel abnormalities, and functional brain disorders. The primary goal is to enhance surgical accuracy and outcomes while minimizing damage to surrounding healthy brain tissue.
Indications
- Brain tumors
- Arteriovenous malformations (AVMs)
- Epileptic foci
- Parkinson’s disease and other movement disorders
- Biopsy of brain lesions
Preparation
- Fasting for a certain period before the procedure, often starting the night before.
- Adjustment or discontinuation of certain medications as advised by the healthcare provider.
- Pre-procedure imaging like MRI or CT scans to map the brain and plan navigation.
- Blood tests to assess overall health and readiness for surgery.
Procedure Description
- Patient lies on the operating table, and the head is secured in a fixed position.
- Anesthesia is administered to ensure the patient does not feel pain during the procedure.
- A small incision is made in the scalp and a tiny hole, or burr hole, is drilled into the skull.
- The stereotactic system combines pre-procedure imaging with real-time tracking to guide instruments to the targeted intracranial area.
- The neurosurgeon performs the required intervention, such as a biopsy, lesion resection, or placement of electrodes.
- The incision is closed and secured with sutures or staples.
Duration
Typically takes between 3 to 6 hours, depending on the complexity of the target and intervention required.
Setting
This procedure is performed in a hospital's neurosurgery operating room equipped with advanced imaging and navigational technology.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
- Radiologic technologist
Risks and Complications
- Infection at the incision site
- Bleeding or hemorrhage
- Damage to surrounding healthy brain tissue
- Neurological deficits, which may be temporary or permanent
- Seizures
Benefits
- Increased accuracy in targeting specific brain regions
- Minimized damage to healthy tissue
- Improved outcomes for patients with complex intracranial conditions
- Shorter recovery times compared to traditional open surgery
Recovery
- Post-procedure monitoring in a hospital setting, typically in an intensive care unit (ICU) initially.
- Pain and discomfort managed with prescribed medications.
- Gradual return to normal activities, following the surgeon's advice.
- Follow-up appointments to monitor recovery and assess the effectiveness of the procedure.
Alternatives
- Traditional open brain surgery: Can be more invasive with longer recovery times.
- Non-surgical treatments: Such as medication, though these may be less effective for certain conditions.
- Gamma Knife radiosurgery: A non-invasive alternative for certain brain lesions and tumors, but not suitable for all conditions.
Patient Experience
During the procedure, the patient is under anesthesia and will not feel pain. Post-procedure, they may experience discomfort or mild pain at the incision site, managed with pain relief medication. Patients generally notice improvements over days to weeks, depending on the condition treated and overall health.