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; each additional hour of attendance by a physician or other qualifie
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; Each Additional Hour of Attendance by a Physician or Other Qualified Personnel
Summary
Functional cortical and subcortical mapping is a procedure where doctors use electrical stimulation and recording techniques to map out vital areas of the brain. This helps in planning surgeries and treating conditions like epilepsy. The procedure allows doctors to provoke seizures intentionally or identify important brain functions by stimulating or recording from electrodes placed either on the brain's surface or deeper inside.
Purpose
This procedure addresses neurological conditions, particularly epilepsy and conditions requiring brain surgery. The goals include accurately locating and preserving vital brain functions, planning effective surgical strategies, and improving seizure control.
Indications
- Drug-resistant epilepsy requiring surgical intervention
- Brain tumors or lesions near vital areas affected by surgery
- Pre-surgical evaluation to minimize risks
- Identifying language, motor, or sensory areas to avoid during surgery
Preparation
- Pre-procedure fasting as advised by the doctor
- Medication adjustments to avoid interactions
- MRI or CT scans for precise brain mapping
- Detailed neurological examination
Procedure Description
- The patient is brought to the operating room or specialized monitoring unit.
- Electrodes are placed either on the brain’s surface or inserted into deeper brain tissue under anesthesia.
- Electrical stimulation is applied to different brain areas while monitoring responses.
- Recording devices monitor brain activity, and any induced seizures or critical functions are observed.
- The procedure is conducted by skilled professionals who document brain responses for surgical planning.
Duration
The procedure typically takes several hours, with each additional hour requiring a dedicated physician or other qualified personnel.
Setting
This procedure is performed in a hospital, often in an operating room or specialized neurological monitoring unit.
Personnel
- Neurosurgeon
- Neurologist
- Anesthesiologist
- Electrophysiology technician
- Specialized nursing staff
Risks and Complications
- Infection at the electrode site
- Bleeding or swelling in the brain
- Seizures induced by stimulation
- Temporary or permanent neurological deficits
- Risks associated with general anesthesia
Benefits
- Accurate localization of vital brain functions
- Improved surgical outcomes with minimal damage to critical areas
- Better seizure control for patients with epilepsy
- Enhanced safety and effectiveness in brain surgeries
Recovery
- Close monitoring in the hospital post-procedure
- Gradual return to normal activities as advised
- Follow-up appointments to assess recovery and discuss results
- Temporary restrictions on certain activities based on doctor’s recommendations
Alternatives
- Non-invasive imaging techniques like functional MRI (fMRI) or magnetoencephalography (MEG)
- Medical management of epilepsy with anti-seizure medications
- Conservative treatment approaches for brain tumors
Patient Experience
During the procedure, the patient may feel minimal discomfort due to anesthesia. Post-procedure, they might experience headaches or mild discomfort at electrode sites, which can be managed with pain medication. Regular communication with the healthcare team will help understand the mapping results and any subsequent steps.