Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical
CPT4 code
Name of the Procedure:
Craniectomy or Craniotomy for Implantation of Neurostimulator Electrodes, Cerebral, Cortical
Summary
This procedure involves surgically opening the skull (either removing a portion temporarily or permanently) to implant electrodes that stimulate the brain's cortex. The goal is to place these neurostimulators in precise locations to help manage certain neurological conditions.
Purpose
The primary purpose of this procedure is to address neurological conditions such as chronic pain, epilepsy, or movement disorders like Parkinson’s disease. The neurostimulators are designed to regulate abnormal electrical activity in the brain, leading to improved symptoms and better quality of life for the patient.
Indications
- Chronic pain that is unresponsive to conservative treatments
- Epilepsy with frequent, uncontrolled seizures
- Movement disorders like Parkinson's disease and dystonia
- Certain psychiatric conditions that have not responded to other treatments
Preparation
- Patients may be asked to fast for several hours before the surgery.
- Medication adjustments might be necessary, especially blood thinners.
- Pre-operative diagnostic tests such as MRI or CT scans to map brain areas.
- Pre-surgical evaluation of the patient's general health status.
Procedure Description
- Anesthesia: General anesthesia is typically administered to put the patient to sleep.
- Incision: A portion of the scalp is shaved and an incision is made.
- Craniectomy/Craniotomy: A bone flap is removed from the skull to access the brain.
- Electrode Placement: Electrodes are carefully placed on the cerebral cortex using image guidance technology.
- Testing Electrode Function: Electrical impulses may be sent through the electrodes to ensure proper placement and function.
- Securing Electrodes: Electrodes are securely positioned, and their wires are tunneled under the scalp to a connector.
- Closing: The bone flap is replaced if a craniotomy was performed and secured with plates and screws; the skin is then sutured.
Duration
The procedure typically takes between 3 to 6 hours, depending on its complexity and the number of electrodes implanted.
Setting
This surgery is performed in a hospital setting, specifically in a neurosurgical operating suite.
Personnel
- Neurosurgeon
- Surgical nurses
- Anesthesiologist
- Neurophysiologist (optional, for intraoperative monitoring)
Risks and Complications
- Infection
- Bleeding or hematoma
- Seizures
- Stroke
- Swelling of the brain tissue
- Hardware malfunction or displacement
- Allergic reactions to anesthesia
Benefits
- Reduction in seizure frequency and severity
- Improvement in chronic pain management
- Alleviation of symptoms related to movement disorders
- Enhanced overall quality of life
Benefits are typically realized within a few weeks to months after surgery and may require subsequent tuning of the neurostimulator settings.
Recovery
- Post-operative care involves monitoring in the hospital for a few days.
- Pain management will be provided.
- Instructions on wound care, activity restrictions, and medication.
- Follow-up appointments for adjustments and evaluations.
- Full recovery can range from a few weeks to several months, depending on individual health and procedure complexity.
Alternatives
- Medications to manage symptoms
- Non-invasive treatments like transcranial magnetic stimulation (TMS)
- Less invasive surgical options such as deep brain stimulation without craniotomy
- Conservative management with physical therapy or lifestyle changes
Each alternative has its own pros and cons, and their effectiveness can vary widely among patients.
Patient Experience
During the procedure, patients under general anesthesia will not be conscious or feel pain. Post-operatively, there may be discomfort, swelling, or headaches, which can be managed with pain relief medications. Patients will be closely monitored for any complications, and most can return to normal activities within weeks, although heavy activities might be restricted for longer. Comfort measures include proper wound care and supportive follow-ups.