Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperat
CPT4 code
Name of the Procedure:
Twist Drill, Burr Hole, Craniotomy, or Craniectomy with Stereotactic Implantation of Neurostimulator Electrode Array in Subcortical Site (e.g., Thalamus, Globus Pallidus, Subthalamic Nucleus, Periventricular, Periaqueductal Gray), Without Intraoperative Guidance.
Summary
This surgical procedure involves creating an opening in the skull to implant a neurostimulator electrode array in specific subcortical regions of the brain. It is done to alleviate symptoms of neurological conditions by electrically stimulating specific brain areas.
Purpose
The procedure addresses neurological disorders such as Parkinson's disease, essential tremor, dystonia, and chronic pain. The goal is to reduce symptoms, improve motor function, and enhance the patient's quality of life.
Indications
- Severe Parkinson's disease with motor fluctuations
- Medically refractory essential tremor
- Dystonia not responsive to medication
- Chronic pain conditions
- Poor response to conventional therapies
Preparation
- Fasting for 8-12 hours prior
- Discontinuation of certain medications as advised by the doctor
- Preoperative imaging studies (e.g., MRI, CT scan)
- Routine blood tests and physical examination
Procedure Description
- Anesthesia: The procedure begins with the administration of general or local anesthesia.
- Incision: A small incision is made in the scalp.
- Burr Hole or Craniotomy: A burr hole or small craniotomy is performed to access the brain.
- Stereotactic Guidance: Using stereotactic imaging and preoperative planning, the neurostimulator electrode array is precisely placed in the targeted subcortical brain region.
- Implantation: The electrode array is securely implanted.
- Closure: The incision is closed, and the patient is monitored as they recover from anesthesia.
Duration
The procedure generally takes between 2 to 4 hours.
Setting
The procedure is performed in a hospital operating room equipped with specialized surgical and imaging technology.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses
- Radiologic technologist (for imaging guidance)
- Operating room technician
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Seizures
- Stroke
- Hardware complications
- Temporary or permanent neurological deficits
Benefits
Patients may experience significant improvement in symptoms, enhanced motor function, and better quality of life within days to weeks following the procedure.
Recovery
- Hospital stay for 1-2 days
- Pain management with medications
- Instructions for incision care
- Restrictions on physical activity for a few weeks
- Follow-up appointments for monitoring and device programming
Alternatives
- Medication management
- Physical and occupational therapy
- Other surgical interventions (e.g., lesioning procedures)
- Pros: Non-surgical options pose less immediate risk.
- Cons: May not be as effective for severe or medication-refractory conditions.
Patient Experience
During the procedure, patients under local anesthesia may experience mild discomfort or pressure in the scalp; those under general anesthesia will be asleep. Postoperatively, patients might feel soreness at the incision site and have strict instructions to manage pain and prevent infection.
Pain will be controlled with medications, and postoperative care will focus on ensuring patient comfort and monitoring for any complications.