Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa)
CPT4 code
Name of the Procedure:
Craniectomy or Craniotomy, Exploratory; Infratentorial (Posterior Fossa)
Summary
A craniotomy or craniectomy in the posterior fossa involves accessing the lower part of the brain, located under the tentorium cerebelli, for either diagnostic or therapeutic purposes. This surgery removes part of the skull to provide the surgeon access to the brain tissue underneath.
Purpose
The procedure is primarily used to diagnose, treat, or remove abnormalities such as tumors, hemorrhages, or infections in the posterior fossa region of the brain. The goal is to alleviate symptoms, remove pathological tissue, and improve neurological function.
Indications
- Symptoms such as severe headaches, balance issues, and coordination problems
- Presence of tumors, cysts, or lesions in the posterior fossa
- Diagnosis and management of intracranial hemorrhages
- Hydrocephalus
Preparation
Patients may be instructed to fast for at least 8 hours before the procedure, adjust medications (e.g., blood thinners), and undergo preoperative assessments such as MRIs or CT scans. A thorough medical history and physical examination are also conducted.
Procedure Description
- The patient receives general anesthesia.
- The head is positioned and stabilized.
- A scalp incision is made, and the underlying skull bone is exposed.
- A section of the skull (craniotomy) or bone (craniectomy) is removed to access the brain.
- The dura mater (outer brain membrane) is opened to explore or treat the underlying brain tissue.
- After the procedure, the dura mater is closed, and the bone is replaced (craniotomy) or left open (craniectomy, often temporarily).
- The scalp is sutured back.
Tools/Technology: Scalpels, drills, retractors, microscopes, and neurosurgical instruments.
Anesthesia: General anesthesia is used to ensure the patient is unconscious and pain-free.
Duration
The procedure typically takes 3 to 5 hours, depending on the complexity and specific condition being treated.
Setting
The procedure is performed in a hospital operating room equipped with advanced neurosurgical facilities.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection and bleeding
- Damage to brain tissue leading to neurological deficits
- Cerebrospinal fluid leaks
- Postoperative swelling or hematoma
- Seizures
Benefits
- Relief from symptoms like headaches and balance problems
- Removal or reduction of tumors or abnormal growths
- Improved neurological function
Most benefits are noticeable within a few weeks post-surgery.
Recovery
- Initial hospital stay of 5-7 days for monitoring
- Pain management with medications
- Gradual return to normal activities over 4-8 weeks
- Follow-up appointments for suture removal and assessment of neurological function
Alternatives
- Radiation therapy or chemotherapy for tumors
- Endoscopic procedures for certain conditions
- Observation and medication management for less severe cases
Pros and Cons: Alternative treatments may be less invasive but could be less effective depending on the condition.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel anything. Postoperatively, the patient may experience mild to moderate pain, managed with medications. They may also feel tired and require assistance with daily activities initially. Regular follow-ups ensure any complications are promptly addressed.