Revision or removal of intracranial neurostimulator electrodes

CPT4 code

Name of the Procedure:

Revision or Removal of Intracranial Neurostimulator Electrodes

Summary

This procedure involves either adjusting, replacing, or completely removing electrodes that have been previously implanted in the brain for neurostimulation purposes.

Purpose

The procedure is undertaken to address issues such as malfunctioning electrodes, infection, or lack of therapeutic benefit from the existing neurostimulator device.

Indications

Malfunctioning or broken electrodes.
Infection around the implant site.
No improvement or worsening of symptoms despite neurostimulation.
Patient experiencing side effects from the device.
Change in medical condition necessitating removal.

Preparation

Fasting for at least 6-8 hours prior to the procedure.
Temporary discontinuation or adjustment of certain medications, particularly blood thinners.
Pre-operative imaging studies like MRI or CT scans.
Routine blood tests and physical examination.

Procedure Description

Administeration of general anesthesia.
A small incision is made in the scalp to access the previously implanted device.
Assessment and adjustment, replacement, or removal of the existing electrodes is conducted.
If removing, electrodes are carefully extracted, and the incision is closed with stitches or staples.
The entire area is cleaned and a dressing is applied to the incision site.

Duration

Typically takes 1 to 3 hours, depending on the complexity.

Setting

The procedure is usually performed in a hospital operating room.

Personnel

Neurosurgeon
Anesthesiologist
Surgical nurses
Radiology technicians (if imaging guidance is needed)

Risks and Complications

Infection
Bleeding or hematoma
Cerebral spinal fluid leakage
Neurological deficits
Seizure
Failure to relieve symptoms
Potential need for further surgeries

Benefits

Restoration of the functionality of the neurostimulation system.
Relief from unwanted side effects or complications from malfunctioning electrodes.
Prevention or treatment of infection.

Recovery

Hospital stay for 1 to 2 days for monitoring.
Mild to moderate pain managed with medications.
Instructions for keeping the incision site clean and dry.
Follow-up appointments for removing stitches and further assessment.
Most patients can return to normal activities within 2-4 weeks.

Alternatives

Medication management
Physical therapy
Other surgeries like Deep Brain Stimulation (DBS) revision.
Each alternative has its own risks and benefits, which should be discussed with the healthcare provider.

Patient Experience

Some pain or discomfort during the first few days post-surgery.
Swelling and bruising around the incision site.
Strict instructions to avoid strenuous activities during early recovery.
Pain management typically involves prescribed pain medications and comfort measures like ice packs.