61108 Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for evacuation and/or drainage of subdural hematoma

Name of the Procedure:

Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for evacuation and/or drainage of subdural hematoma.

Summary

This procedure involves creating a small hole in the skull using a twist drill to relieve pressure from blood accumulation inside the brain. It is primarily performed to treat conditions like subdural hematomas, where blood collects between the brain and its outer covering.

Purpose

• To alleviate pressure on the brain caused by a subdural hematoma.
• To drain accumulated blood, reducing the risk of brain damage and improving patient outcomes.

Indications

• Symptoms such as severe headache, confusion, weakness, seizures, or loss of consciousness.
• Diagnosed subdural hematoma via imaging studies like CT scans or MRIs.
• Patients with increased intracranial pressure.

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Adjustments to medications, particularly blood thinners, may be necessary.
• Pre-procedure imaging studies and neurological assessments.

Procedure Description

1. The patient is positioned, and the scalp is cleaned and sterilized.
2. Local anesthesia or sedation is administered.
3. A small incision is made in the scalp.
4. A twist drill is used to create a small hole in the skull.
5. A catheter or drainage tube is inserted through the hole to evacuate the hematoma.
6. The incision is closed, and the drainage setup is secured.

Duration

The procedure typically takes about 30 minutes to 1 hour, depending on the complexity.

Setting

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

Personnel

• Neurosurgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

• Bleeding or infection
• Brain tissue damage
• Recurrence of the hematoma
• Seizures
• Complications related to anesthesia

Benefits

• Rapid reduction in intracranial pressure.
• Relief from symptoms like headache and neurological deficits.
• Improved chances of recovery and reduced risk of long-term brain damage.

Recovery

• Monitoring in a recovery room or intensive care unit.
• Instructions for wound care and activity restrictions.
• Follow-up imaging to ensure the hematoma has been adequately drained.
• Possible short-term stay in the hospital for observation.

Alternatives

• Burr hole drainage: a similar but slightly larger hole is created.
• Craniotomy: a larger section of the skull is removed.
• Conservative management with medications (if the hematoma is small and not causing significant symptoms).
• Pros and cons: Less invasive procedures may have quicker recovery but may not be suitable for larger hematomas.

Patient Experience

• Mild discomfort or pain at the incision site, manageable with medication.
• Possible sensations of pressure relief once the hematoma is drained.
• Recommendations for rest, limited physical activity, and avoiding certain medications.
• Regular follow-up appointments to monitor recovery.