Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or C1-C3 vertebral bodies; extradural
CPT4 code
Name of the Procedure:
Resection or Excision of Neoplastic, Vascular, or Infectious Lesion at the Base of Posterior Cranial Fossa, Jugular Foramen, Foramen Magnum, or C1-C3 Vertebral Bodies; Extradural
Summary
This procedure involves the surgical removal of abnormal growths, blood vessel abnormalities, or infections located at the base of the skull or the upper part of the spinal column. Surgeons access these areas from outside the protective coverings of the brain or spinal cord.
Purpose
This procedure addresses serious medical conditions such as tumors, vascular malformations, or infections that affect crucial areas at the skull base and upper cervical spine. The goal is to remove these lesions to relieve symptoms, prevent further complications, and improve overall neurological function.
Indications
- Persistent headaches, neck pain, or dizziness.
- Neurological deficits like limb weakness, sensory loss, or difficulty speaking or swallowing.
- Evidence of tumor, vascular abnormality, or infection on imaging studies (MRI, CT).
- Progressive neurological deterioration.
Preparation
- Patients may need to fast for 8-12 hours before the procedure.
- Medications adjustments could be required, particularly those affecting blood clotting.
- Preoperative imaging (CT, MRI) and blood tests will be performed.
- Discussions with the anesthesiology team about anesthesia and any potential risks.
Procedure Description
- The patient is placed under general anesthesia.
- A careful incision is made at a specific location to access the targeted area externally.
- Specialized surgical tools are used to remove the lesion while minimizing impact on surrounding structures.
- Intraoperative imaging may be used to guide the procedure accurately.
- The incision is closed with sutures or staples upon completion.
Duration
The procedure generally lasts between 4 to 8 hours, depending on the complexity and location of the lesion.
Setting
The procedure is performed in a hospital, specifically in a neurosurgical operating theater.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses
- Radiologists for intraoperative imaging support
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Damage to adjacent nerves or blood vessels resulting in neurological deficits
- Cerebrospinal fluid leak
- Anesthetic complications
- Postoperative pain or discomfort
Benefits
- Relief from symptoms associated with the lesion (headaches, pain, neurological deficits).
- Prevention of further neurological decline.
- Potential improvement in quality of life and functional abilities.
Recovery
- Initial hospital stay of 3-7 days for monitoring and recovery.
- Pain management with prescribed medications.
- Postoperative imaging to assess surgical outcomes.
- Restricted activities for several weeks; no heavy lifting or strenuous activity.
- Follow-up appointments for wound check and neurological assessment.
Alternatives
- Stereotactic radiosurgery, though less effective for large or invasive lesions.
- Chemotherapy or radiation therapy for malignant tumors.
- Conservative management with observation, especially if symptomatic management is possible.
Patient Experience
- During the procedure: Patients will be under general anesthesia and will not feel pain.
- After the procedure: Some pain and discomfort near the incision site, managed with medication.
- Neurological symptoms may improve gradually over weeks to months.
- Rehabilitation therapy might be needed to optimize recovery.