Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; intradural, including dural repair, with or without graft
CPT4 code
Name of the Procedure:
Resection or Excision of Neoplastic, Vascular or Infectious Lesion of Parasellar Area, Cavernous Sinus, Clivus or Midline Skull Base; Intradural, Including Dural Repair, With or Without Graft.
Summary
This surgical procedure involves removing abnormal growths such as tumors, vascular anomalies, or infections located in the parasellar region, cavernous sinus, clivus, or midline skull base. The surgeon operates within the dura mater (the tough outer membrane covering the brain and spinal cord) and may repair or reinforce the dura after removing the lesion, potentially using a graft.
Purpose
The purpose of this procedure is to remove pathological lesions that can compress nearby nerves, blood vessels, or brain structures, leading to significant neurological symptoms or health risks. The goals include alleviating symptoms, preventing further neurological damage, and improving the patient's quality of life.
Indications
- Presence of neoplasms (tumors), such as pituitary adenomas or meningiomas.
- Vascular disorders, such as cavernous sinus thrombosis or arteriovenous malformations.
- Infectious lesions, including abscesses or granulomas.
- Symptoms such as persistent headaches, vision problems, hormonal imbalances, or cranial nerve deficits.
- Patients who have not responded to conservative treatments or for whom surgical intervention is urgent due to the risk of complications.
Preparation
- Fasting for at least 8 hours before the surgery.
- Adjusting or stopping certain medications as directed by the healthcare provider.
- Undergoing pre-operative imaging studies such as MRI or CT scans.
- Completing blood tests and other necessary medical evaluations.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision: A surgical incision is made, typically through the skull base, to access the targeted area.
- Resection/Excision: Using specialized surgical instruments, the surgeon carefully removes the lesion.
- Dural Repair: If the dura is cut or damaged, it is repaired or reinforced, sometimes using a graft material.
- Closure: The surgical site is closed with sutures, and the scalp is secured.
Advanced imaging techniques and neuronavigation systems may be used to enhance precision.
Duration
The procedure typically takes 4-8 hours, depending on the complexity and location of the lesion.
Setting
The surgery is performed in a hospital setting, usually within a specialized neurosurgical operating room.
Personnel
- Neurosurgeon
- Surgical nurses
- Anesthesiologist
- Surgical technologists
- Potentially, a second neurosurgeon or other specialists as needed
Risks and Complications
- Infection or bleeding
- Cerebrospinal fluid leakage
- Neurological deficits, such as vision problems or cranial nerve damage
- Stroke or other vascular complications
- Reaction to anesthesia
- Recurrence of the lesion
Benefits
- Relief from symptoms caused by the lesion
- Restoration of normal neurological functions
- Prevention of further health complications
- Improved quality of life, potentially noticeable in weeks to months post-surgery
Recovery
- Initial recovery in the ICU for close monitoring.
- Hospital stay of around 3-7 days.
- Pain management through medications.
- Gradual resumption of normal activities, with full recovery expected in weeks to a few months.
- Follow-up appointments to monitor healing and evaluate the success of the procedure.
Alternatives
- Medical management with drugs (e.g., steroids, antibiotics for infections).
- Radiation therapy or radiosurgery.
- Less invasive surgical techniques, if applicable.
- Observation and regular monitoring for smaller, asymptomatic lesions.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel or remember anything. Post-operatively, the patient may experience some pain, swelling, and fatigue, managed with medication. Gradual improvement in symptoms is expected, along with regular follow-ups to monitor recovery.
Pain management includes prescribed analgesics and comfort measures such as ice packs and rest.