95836 Electrocorticogram from an implanted brain neurostimulator pulse generator/transmitter, including recording, with interpretation and written report, up to 30 days

Name of the Procedure:

Electrocorticogram (ECoG) from an implanted brain neurostimulator pulse generator/transmitter, including recording, with interpretation and written report, up to 30 days.

Summary

An electrocorticogram (ECoG) is a procedure where electrical activity from the brain is recorded using electrodes placed directly on the brain's surface. This specific procedure involves using an implanted neurostimulator pulse generator to record brain activity over up to 30 days, providing detailed data which is then interpreted, and a written report is generated.

Purpose

The procedure is most commonly used to monitor and map brain activity for patients with epilepsy, brain tumors, or other neurological disorders. The goal is to precisely locate abnormal brain activity areas to aid in diagnosis and treatment planning.

Indications

• Uncontrolled epilepsy or seizures.
• Evaluation prior to epilepsy surgery.
• Monitoring brain function during surgical removal of brain tumors.
• Conditions causing abnormal brain electrical activity.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Adjustments to current medication regimens might be necessary.
• Pre-procedure assessments may include MRI or CT scans and a detailed neurological examination.

Procedure Description

1. The patient undergoes surgery to implant the neurostimulator pulse generator and electrodes on the brain surface.
2. The implanted device records electrical brain activity for up to 30 days.
3. Data is continuously transmitted from the device for monitoring.
4. Skilled electrophysiologists and neurologists interpret the recorded data.
5. A comprehensive written report is provided to discuss the findings and implications.

Tools and Equipment Used:

• Implanted neurostimulator pulse generator.
• Electrode arrays.

Anesthesia:

• General anesthesia is used during the initial implantation surgery.

Duration

The recording duration can last up to 30 days. The initial implantation surgery generally takes a few hours.

Setting

• The implantation is performed in a hospital or surgical center.
• Ongoing monitoring can often be managed at home, with regular check-ins at an outpatient clinic.

Personnel

• Neurosurgeons for the implantation procedure.
• Neurologists and electrophysiologists for recording and interpretation.
• Nursing staff for perioperative care.

Risks and Complications

• Infection at the implantation site.
• Bleeding or swelling in the brain.
• Device malfunction.
• Discomfort or pain at the implant site.

Benefits

• Precise localization of abnormal brain activity.
• Improved treatment outcomes for epilepsy or brain surgery.
• Enhanced monitoring of neurological conditions.

Recovery

• Post-surgery recovery involves hospital observation, typically for a few days.
• Patients may experience some discomfort or pain at the incision site, managed through prescribed pain medication.
• Follow-up appointments will be necessary to analyze collected data and remove the device if needed.

Alternatives

• Non-invasive EEG (electroencephalogram).
• Magnetoencephalography (MEG).
• Medication management alone.
• Each alternative varies in accuracy and level of detail compared to ECoG.

Patient Experience

During the implantation:

• Under general anesthesia with no conscious experience. Post-implantation:
• Some initial postoperative pain managed by pain relief measures.
• Possible mild discomfort from the implanted device.
• Regular follow-ups ensure the patient's comfort and procedure effectiveness.