Transcondylar (far lateral) approach to posterior cranial fossa, jugular foramen or midline skull base, including occipital condylectomy, mastoidectomy, resection of C1-C3 vertebral body(s), decompression of vertebral artery, with or without mobilization
CPT4 code
Name of the Procedure:
Transcondylar (far lateral) approach to posterior cranial fossa, jugular foramen, or midline skull base, including occipital condylectomy, mastoidectomy, resection of C1-C3 vertebral body(s), decompression of vertebral artery, with or without mobilization.
Summary
This procedure involves accessing the posterior cranial fossa, jugular foramen, or midline skull base to address various conditions affecting these regions. It requires the removal of portions of the skull and vertebrae for better exposure and may include decompressing the vertebral artery to relieve pressure.
Purpose
The procedure is performed to treat conditions such as tumors, vascular abnormalities, or compressive lesions in the posterior cranial fossa or skull base regions. The goal is to remove or alleviate the problem while ensuring minimal damage to surrounding brain and nerve structures.
Indications
- Tumors affecting the posterior cranial fossa or jugular foramen
- Vascular anomalies such as aneurysms or arteriovenous malformations
- Lesions causing compression of cranial nerves or brainstem
- Persistent pain or neurologic deficits stemming from the affected areas
Preparation
- Fasting for at least 8 hours prior to the procedure
- Adjustments to medications as directed by the healthcare provider
- Preoperative imaging such as MRI or CT scans to map the anatomy
- Blood tests and other assessments to ensure the patient is fit for surgery
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made near the posterior base of the skull.
- Removal of part of the occipital bone (condylectomy) and sections of two vertebrae (C1-C3) to access the surgical site.
- A mastoidectomy (removal of part of the mastoid bone) may be performed if necessary.
- The vertebral artery is decompressed and, if required, mobilized to create a clear operative field.
- The lesion or abnormality is addressed through resection or decompression.
- The surgical site is closed and dressed properly.
Duration
The procedure typically takes 4 to 8 hours, depending on the complexity and extent of the surgery.
Setting
The procedure is performed in a hospital's operating room.
Personnel
- Neurosurgeon
- Surgical nurse
- Anesthesiologist
- Operating room technologists
- Possibly an interventional radiologist or neurologist for intraoperative guidance
Risks and Complications
- Infection
- Bleeding
- Cerebrospinal fluid leak
- Nerve damage leading to sensory or motor deficits
- Stroke or vascular complications
- Postoperative pain and wound complications
- Adverse reactions to anesthesia
Benefits
The main benefits include alleviation of symptoms, removal of the causative lesion, improved neurological function, and prevention of further complications. Benefits typically begin to manifest shortly after recovery but may continue to improve over months.
Recovery
- Close monitoring in the ICU immediately post-surgery
- Pain management through prescribed medications
- Physical and/or occupational therapy as needed
- Avoidance of strenuous activities for at least 4 to 6 weeks
- Follow-up appointments for imaging and to monitor recovery
Alternatives
- Stereotactic radiosurgery
- Endoscopic skull base surgery
- Medical management for less severe cases
- Observation with routine imaging and clinical follow-up
- Each alternative varies in risk, recovery time, and suitability based on the specific condition.
Patient Experience
During the procedure, the patient is under general anesthesia and will not be conscious. Postoperatively, patients may experience pain, swelling, and limited mobility which are managed with medications and supportive care. A hospital stay of several days to a week is typical, followed by recovery at home with gradual return to normal activities.