CPT® Code 61323

1. Indications

The procedure is indicated for the treatment of intracranial hypertension, which may arise from various medical conditions. The following are specific indications for performing this procedure:

• Intracranial Hypertension Increased pressure within the skull that can lead to brain damage if not addressed.
• Traumatic Brain Injury Severe head injuries that result in swelling or bleeding within the brain.
• Stroke Ischemic or hemorrhagic strokes that cause significant brain swelling.
• Neurological Disorders Conditions that lead to increased intracranial pressure, necessitating surgical intervention.

2. Procedure

The procedure involves several critical steps to ensure effective decompression of the brain. The following outlines the procedural steps:

• Step 1: Creation of Scalp Flaps The surgeon begins by making incisions in the scalp to create flaps, which allows access to the underlying skull. This step is crucial for exposing the area where the craniectomy or craniotomy will be performed.
• Step 2: Burr Holes Several burr holes are drilled into the skull to facilitate the cutting of the bone. These holes serve as access points for the subsequent steps of the procedure.
• Step 3: Bone Flap Removal The bone between the burr holes is carefully cut using a saw or craniotome. The bone flap is then raised, which may be temporarily or permanently removed, depending on the specific needs of the patient.
• Step 4: Dura Opening and Duraplasty In a craniotomy, the dura mater is opened to access the brain. If duraplasty is indicated, a graft may be used to enlarge the dura, allowing for adequate decompression of the brain. This graft can be an autologous galeal flap, a cultured dermal graft, or a synthetic patch graft.
• Step 5: Suturing and Drain Placement The dura and/or dural graft is tightly sutured to prevent cerebrospinal fluid leakage. A drain is then placed to manage any excess fluid that may accumulate post-operatively.
• Step 6: Bone Flap Management The bone flap is either replaced over the dura and secured with steel sutures or excised and stored in an abdominal pocket or bone bank until cerebral swelling has resolved.
• Step 7: Lobectomy In this specific procedure, a lobectomy is performed where swollen brain tissue is removed to further control intracranial pressure, ensuring that the brain has adequate space to expand and function properly.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as infection or cerebrospinal fluid leaks. Patients may require intensive care for close observation of neurological status and management of intracranial pressure. Recovery may involve pain management and rehabilitation, depending on the extent of the surgery and the patient's overall condition. Follow-up imaging may be necessary to assess the brain's response to the procedure and ensure that intracranial pressure is adequately controlled.