Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material(s), followed by contrast material(s) a
CPT4 code
Name of the Procedure:
Magnetic Resonance Imaging (MRI) of the Brain During Open Intracranial Procedure
Summary
This procedure involves using MRI technology to capture detailed images of the brain, including the brain stem and skull base, during an open brain surgery. Initially, images are taken without contrast material, followed by images taken after a contrast agent is administered to better visualize structures and any abnormalities.
Purpose
This procedure is designed to assess for any residual tumor or vascular malformation during brain surgery. It ensures that surgeons can make real-time decisions to remove as much of the problematic tissue as possible while minimizing harm to healthy brain areas.
Indications
- Patients undergoing surgery for brain tumors
- Individuals with known or suspected vascular malformations in the brain
- Patients requiring intraoperative imaging to guide surgical decisions
Preparation
- Patients may need to fast for a certain period before the procedure
- Adjustment of certain medications may be necessary
- Preoperative MRI scans and other imaging studies are typical prerequisites
Procedure Description
- The patient undergoes an open intracranial procedure under general anesthesia.
- Intraoperative MRI equipment is set up around the surgical area.
- MRI images are taken initially without contrast material.
- A contrast agent is then administered to the patient.
- Additional MRI images are taken to assess any remaining tumor or malformation.
- Surgeons analyze the images and continue surgery based on the findings.
- The entire MRI process is repeated as necessary before concluding the surgery.
Tools: MRI scanner, contrast agents, surgical instruments. Anesthesia: General anesthesia is required.
Duration
The MRI process, including initial and subsequent imaging, typically takes around 1-2 hours, intertwined with the overall surgical time.
Setting
The procedure is performed in a hospital operating room equipped with intraoperative MRI technology.
Personnel
- Neurosurgeon
- Radiologist
- Anesthesiologist
- MRI technologist
- Operating room nurses and surgical assistants
Risks and Complications
- Adverse reactions to the contrast material
- Potential for extended surgery time
- MRI-related risks such as issues with metal implants or devices
- General surgical risks like infections, bleeding, or neurological deficits
Benefits
- Improved surgical outcomes by ensuring complete removal of abnormal tissue
- Real-time assistance in surgical planning and decision-making
- Minimized need for follow-up surgeries
Recovery
- Immediate post-procedure care in a recovery room or ICU
- Monitoring for any adverse reactions to the contrast material or surgical complications
- Recovery time varies based on the overall surgery but may take several weeks
- Follow-up appointments for reassessment and additional imaging if necessary
Alternatives
- Traditional surgery without intraoperative imaging
- Preoperative and postoperative MRI scans without real-time guidance
- Non-surgical treatments like radiotherapy or chemotherapy for tumors
Patient Experience
Patients will not experience the MRI process directly due to being under general anesthesia. Post-surgery, they may experience typical recovery symptoms such as pain, fatigue, and incision site discomfort. Pain management and comfort measures will be provided as necessary.