CPT® Code 61321

1. Indications

The procedure is indicated for the following conditions:

• Intracranial Abscess - Presence of a pus-filled cavity within the infratentorial region of the brain, which may cause increased intracranial pressure or neurological deficits.
• Infection - Situations where an infection in the brain has led to the formation of an abscess that requires surgical intervention for drainage.
• Neurological Symptoms - Patients exhibiting symptoms such as headache, fever, altered mental status, or focal neurological deficits that suggest the presence of an abscess.

2. Procedure

The procedure involves several critical steps to ensure effective drainage of the abscess:

• Scalp Flap Creation - The surgeon begins by creating scalp flaps to access the underlying skull. This involves making incisions in the scalp to allow for the elevation of the skin and soft tissue.
• Burr Holes Drilling - After the scalp flaps are raised, the surgeon drills several burr holes in the skull to facilitate access to the brain. These holes are strategically placed based on the location of the abscess.
• Bone Flap Removal - The bone between the burr holes is then cut using a saw or craniotome, and a bone flap is raised. This flap may be temporarily or permanently removed to provide access to the brain.
• Abscess Identification - The surgeon identifies the abscess, which may be located in either an eloquent or non-eloquent region of the brain. If the abscess is in a non-eloquent area, the wall of the abscess is dissected from the surrounding brain tissue.
• Abscess Drainage - For abscesses located in eloquent regions, an operative microscope is utilized to visualize and preserve critical cortical vessels. The abscess wall is opened widely to create a pouch (marsupialization), and the pus is aspirated from the cavity.
• Cavity Irrigation - After aspiration, the cavity is irrigated with saline solution to ensure that all infectious material is removed.
• Dural Closure - Once the procedure is complete, the dural flap is placed back over the exposed brain and secured with sutures, ensuring a tight closure to prevent cerebrospinal fluid leakage.
• Bone Flap Reattachment - The bone flap is then repositioned over the dura and anchored with steel sutures. In some cases, a craniectomy defect may be filled with bone wax or silicone to provide stability.
• Layered Closure - Finally, the fascia and muscle layers are closed, followed by the scalp, which is sutured in a layered fashion to promote optimal healing.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as infection or cerebrospinal fluid leakage. Patients may require imaging studies to assess the success of the drainage and to ensure that no residual abscess remains. Recovery may vary depending on the extent of the surgery and the patient's overall health. Pain management and neurological assessments are critical components of post-operative care. Additionally, patients may need rehabilitation services to address any neurological deficits resulting from the abscess or the surgical intervention.