Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; intradural, including dural repair, with or without graft
CPT4 code
Name of the Procedure:
Resection or Excision of Neoplastic, Vascular, or Infectious Lesion of the Base of the Anterior Cranial Fossa; Intradural, Including Dural Repair, With or Without Graft
Summary
This surgical procedure involves the removal of abnormal growths or lesions from the base of the anterior cranial fossa, which is the front portion of the floor of the skull. The operation also includes repairing the dura mater (the tough outer membrane of the brain), and may involve the use of tissue grafts.
Purpose
The procedure aims to treat abnormal lesions, which can be neoplastic (related to tumor growth), vascular (related to blood vessels), or infectious. The primary goal is to remove the lesion to alleviate symptoms, prevent further complications, and improve the patient's quality of life.
Indications
- Persistent or severe headaches
- Neurological deficits (e.g., seizures, vision problems, weakness)
- Diagnosed tumors or vascular malformations via imaging techniques
- Infections that do not respond to medical treatment
- Symptoms suggesting increased intracranial pressure
Preparation
- Fasting for 8-12 hours prior to surgery
- Discontinuation or adjustment of certain medications (e.g., blood thinners)
- Preoperative imaging (MRI or CT scans) to assess the lesion
- Blood tests and medical clearance
Procedure Description
- The patient is administered general anesthesia.
- A surgical incision is made through the scalp and skull to access the base of the anterior cranial fossa.
- The dura mater is carefully opened to reveal the lesion.
- The lesion is meticulously resected or excised using specialized surgical instruments.
- Dural repair is performed, using autografts or synthetic grafts if necessary.
- The surgical site is closed, and the scalp is sutured back in place.
Duration
The procedure typically takes between 4 to 8 hours, depending on the complexity and size of the lesion.
Setting
Most commonly performed in a hospital operating room equipped with advanced neurosurgical instruments and imaging technologies.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
- Possibly a plastic surgeon for grafting, if needed
Risks and Complications
- Infection
- Bleeding or hematoma
- Neurological impairments (e.g., loss of sensation, motor skills)
- Cerebrospinal fluid leakage
- Anesthesia-related complications
- Graft rejection (if used)
Benefits
- Removal of the lesion can alleviate symptoms and prevent further damage.
- Improvement in neurological function.
- Reduced risk of complications such as stroke or infection.
- Enhanced quality of life post-recovery.
Recovery
- Close monitoring in the intensive care unit (ICU) for a few days post-surgery.
- Pain management and antibiotics to prevent infection.
- Gradual return to normal activities over 4 to 6 weeks.
- Follow-up appointments for imaging and neurological assessments.
Alternatives
- Stereotactic radiosurgery for treating small lesions.
- Endoscopic skull base surgery for less invasive removal.
- Medical management with chemotherapy or radiotherapy for tumors.
- Observation and regular monitoring if the lesion is asymptomatic and not causing harm.
Patient Experience
Patients may experience some discomfort and swelling initially. Pain is managed with medications. Sensory or motor functions might be temporarily affected but usually improve as healing progresses. Regular follow-up ensures a smooth recovery and addresses any concerns promptly.