62121 Craniotomy for repair of encephalocele, skull base

Name of the Procedure:

Craniotomy for Repair of Encephalocele, Skull Base

Summary

A craniotomy for the repair of encephalocele is a surgical procedure where a section of the skull is temporarily removed to access and repair a congenital defect that allows brain tissue to protrude through an opening in the skull base.

Purpose

This procedure addresses the medical condition known as encephalocele, where brain tissue and membranes push out through abnormal openings in the skull. The primary goal is to close the defect, protect the brain tissue, and restore normal skull anatomy and function.

Indications

• Visible protrusion of brain tissue through the skull (encephalocele)
• Neurological symptoms such as seizures, developmental delays, or hydrocephalus
• Recurrent infections or cerebrospinal fluid leaks

Preparation

• Patients may be required to fast for at least 8 hours before the procedure.
• Adjustment or discontinuation of certain medications, especially blood thinners.
• Pre-operative imaging studies such as MRI or CT scans to assess the extent of the encephalocele.
• Pre-surgical physical examination and blood tests.

Procedure Description

1. General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. The surgeon makes an incision in the scalp and temporarily removes a section of the skull (craniotomy) to access the brain and the encephalocele.
3. The brain tissue and membranes are carefully repositioned, and the defect in the skull base is repaired, often using grafts or synthetic materials.
4. The removed portion of the skull is replaced and secured, and the scalp is closed with sutures or staples.
5. A drain may be placed to remove excess fluid postoperatively.

Duration

The procedure typically takes between 3 to 6 hours, depending on the complexity of the defect.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Radiologist (potential involvement for intraoperative imaging)

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Damage to surrounding brain tissue, potentially causing neurological deficits
• Cerebrospinal fluid leak
• Seizures
• Reaction to anesthesia

Benefits

• Reduction or elimination of neurological symptoms caused by the encephalocele
• Decreased risk of infections and complications associated with exposed brain tissue
• Improved cosmetic appearance of the skull and scalp

Recovery

• Hospital stay of 3 to 7 days for monitoring and initial recovery
• Pain management with medications and comfort measures
• Rest and limited physical activity for several weeks
• Follow-up appointments for suture removal and to monitor healing
• Possible rehabilitation therapy depending on neurological impact

Alternatives

• Conservative management (if the encephalocele is small and asymptomatic, though this is rare)
• Symptomatic treatment for associated conditions without directly addressing the encephalocele
• Endoscopic procedures if the encephalocele is small and in a location accessible via less invasive techniques

Patient Experience

• Patients will be under general anesthesia during the surgery and will not feel pain during the procedure.
• Post-procedure, patients may experience discomfort or headaches, manageable with pain medications.
• There might be temporary swelling or bruising around the surgical site.
• Gradual return to daily activities as per the surgeon’s guidance, typically within a few weeks.