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), with use of intraoperative
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), with Use of Intraoperative Guidance
Summary
This surgical procedure involves creating a small opening in the skull to implant a neurostimulator electrode array into specific subcortical areas of the brain. The goal is to deliver targeted electrical stimulation to treat neurological conditions. Intraoperative techniques such as imaging and monitoring are used to guide the precise placement of the electrodes.
Purpose
This procedure aims to address conditions like Parkinson's disease, dystonia, essential tremor, and chronic pain. The intended goal is to improve motor function, reduce symptoms, and enhance the patient's quality of life.
Indications
- Severe, medication-resistant Parkinson's disease or dystonia
- Disabling essential tremor
- Chronic pain unresponsive to conventional treatments
- Patient is in good overall health and able to withstand surgery
Preparation
- Fasting for at least 8 hours before the procedure
- Medication adjustments as advised by the healthcare provider
- Preoperative imaging (MRI or CT scans) to plan electrode placement
- Comprehensive neurological evaluation
Procedure Description
- Anesthesia: Administer general or local anesthesia depending on the patient's condition and the surgeon's preference.
- Positioning: The patient’s head is positioned and immobilized using a stereotactic frame.
- Imaging: Intraoperative MRI or CT scans are performed to guide electrode placement accurately.
- Incision and Drilling: A small incision is made in the scalp, followed by creating a burr hole or performing a craniotomy/craniectomy to access the brain.
- Electrode Placement: The neurostimulator electrode array is carefully inserted into the targeted subcortical site using stereotactic guidance.
- Verification: Intraoperative tests and imaging confirm the correct positioning of the electrodes.
- Closure: The incision is closed, and sterile dressings are applied.
Duration
The procedure typically lasts between 4 to 6 hours.
Setting
The procedure is performed in a hospital's operating room equipped with advanced imaging and monitoring technologies.
Personnel
- Neurosurgeon
- Anesthesiologist
- Neurologist (intraoperative monitoring)
- Surgical nurses and technicians
Risks and Complications
- Infection at the incision site
- Bleeding or stroke
- Hardware-related complications (e.g., electrode migration or malfunction)
- Potential neurological deficits (e.g., speech or motor impairment)
- Anesthesia-related risks
Benefits
- Significant reduction in symptoms such as tremor, rigidity, and chronic pain
- Improvement in daily activities and overall quality of life
- Benefits can be observed within a few weeks after the procedure
Recovery
- Hospital stay for a few days post-surgery
- Regular follow-up appointments for adjustments of the neurostimulator settings
- Gradual return to normal activities, typically within a few weeks
- Temporary restrictions on strenuous activities and driving
Alternatives
- Medication therapy (less effective in advanced cases)
- Physical and occupational therapy
- Ablative surgical procedures (less commonly used)
Patient Experience
- Patients may experience mild discomfort or headache at the surgical site.
- Pain management includes prescribed medications to ensure comfort.
- Initial adjustment period for neurostimulator settings may be needed, with several follow-up visits.