Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays

CPT4 code

Name of the Procedure:

Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays.
Common name(s): Neurostimulator implantation, Cranial stimulator surgery

Summary

This procedure involves placing or replacing a device in the skull that sends electrical signals to the brain. These signals can help manage certain neurological conditions by altering brain activity. The device is connected to multiple electrode arrays placed in specific brain regions.

Purpose

The procedure addresses various neurological conditions like chronic pain, movement disorders (e.g., Parkinson's disease), epilepsy, and certain mental health conditions. The goal is to reduce symptoms, improve quality of life, and enhance daily functioning.

Indications

Chronic, untreatable pain
Parkinson's disease or other movement disorders
Epilepsy that does not respond to medication
Certain psychiatric disorders, such as major depression
Candidates typically have not found relief through other treatments

Preparation

Pre-procedure fasting as directed by the medical team
Medication adjustments, especially for blood thinners or other critical medications
Diagnostic tests such as MRI or CT scans to map brain areas
Comprehensive health assessment including blood work and cardiac evaluation

Procedure Description

Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
Incision: A scalp incision is made for access to the skull.
Craniotomy: Small sections of the skull are removed to reach the brain.
Electrode Placement: Electrode arrays are inserted into specific brain regions identified by pre-procedure imaging.
Device Insertion: The neurostimulator pulse generator or receiver is implanted beneath the skin (typically near the collarbone).
Connection: Wires are tunneled under the skin from the device to the electrode arrays.
Testing: The system is tested for proper function before closing the incision.
Closure: Incisions are closed with sutures or staples.

Duration

Typically, the procedure takes about 2 to 5 hours, depending on its complexity.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

Neurosurgeon
Anesthesiologist
Surgical nurses and technicians
Neurologist (in some cases)

Risks and Complications

Infection at the incision site
Bleeding or swelling in the brain
Device malfunction or failure requiring further surgery
Seizures or changes in neurological function
Cerebrospinal fluid leakage
Pain at the implantation site
Rare risk of stroke

Benefits

Reduction in symptoms associated with the neurological condition
Improved quality of life and functional ability
Benefits can often be realized within weeks of the procedure

Recovery

Hospital stay for monitoring, usually 1 to 3 days
Post-operative pain management with prescribed medications
Follow-up appointments for device programming and adjustments
Activity restrictions: Avoid heavy lifting and intense activity for a few weeks
Gradual return to normal activities as advised by the medical team

Alternatives

Medication management
Non-invasive brain stimulation techniques (e.g., Transcranial Magnetic Stimulation)
Surgical interventions like deep brain stimulation without multiple electrode arrays
Each alternative comes with its own pros and cons, varying effectiveness, and side effects

Patient Experience

During the procedure: The patient is under general anesthesia and will not feel pain or be aware of the surgery.
After the procedure: Expect soreness and mild pain at incision sites, manageable with pain medications.
Device adjustments might be necessary, typically done in follow-up visits.
Gradual improvement in symptoms over days to weeks, depending on the condition being treated.