Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician or other qualified health
CPT4 code
Name of the Procedure:
Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician or other qualified health.
Summary
This procedure involves placing electrodes on or inside the brain to map its functional areas and identify critical structures. By stimulating or recording brain activity, doctors can provoke seizures or locate essential areas involved in movement, sensation, or language.
Purpose
This procedure is used to:
- Pinpoint areas of the brain responsible for critical functions.
- Identify regions where seizures originate.
- Guide surgical planning to avoid damaging vital brain areas.
Indications
- Patients with epilepsy who are candidates for surgery.
- Individuals undergoing brain tumor or lesion removal.
- Patients needing localization of functional brain areas before neurosurgery.
Preparation
- Patients may need to fast for a certain period before the procedure.
- Medication adjustments may be necessary.
- Pre-procedure diagnostics may include MRI or CT scans to assist with electrode placement.
Procedure Description
- Anesthesia: The patient is typically placed under general anesthesia.
- Placement: Electrodes are placed directly on the brain's surface or inserted into the brain's depth via a small opening in the skull.
- Stimulation/Recording: Electrical stimulation or recording of brain activity is performed to map out functional areas or provoke seizures.
- Monitoring: The patient is closely monitored for responses and seizure activity.
Duration
The initial mapping typically takes about one hour, but the entire process may extend over several hours or days, depending on the complexity.
Setting
The procedure is performed in a hospital setting, usually in a specialized neurosurgery unit.
Personnel
- Neurosurgeon
- Neurologist
- Anesthesiologist
- Specialized nurses and technicians
Risks and Complications
- Infection
- Bleeding
- Swelling
- Seizure induction
- Temporary or permanent damage to healthy brain tissue
Benefits
- Accurate identification of brain areas critical for functions like movement, speech, and sensation.
- Improved outcomes of neurosurgery by preserving essential brain functions.
- More effective treatment of epilepsy and other neurological conditions.
Recovery
- Close monitoring in a hospital setting after the procedure.
- Recovery time varies; hospitalization may last from a few days to a couple of weeks.
- Restrictions on physical activity and follow-up appointments for further assessment.
Alternatives
- Non-invasive imaging techniques like functional MRI or magnetoencephalography.
- Observation and medication adjustments without surgical intervention.
- Each alternative has its benefits and drawbacks compared to direct brain mapping.
Patient Experience
- Patients may experience discomfort due to electrode implantation.
- Sedation and pain management strategies are employed.
- Some parts of the procedure may be performed while the patient is awake to monitor responses.