CPT® Code 61460

1. Indications

The procedure described by CPT® Code 61460 is indicated for the treatment of specific conditions that result from the compression of cranial nerves. These conditions include:

• Severe Vertigo - This symptom can arise from Meniere's disease, a disorder of the inner ear that affects balance and hearing, or vestibular neuritis, which is an inflammation of the vestibular nerve.
• Tinnitus - This condition involves hearing ringing or other noises in the ears, often linked to the compression of the cochlear nerve.

2. Procedure

The surgical procedure for CPT® Code 61460 involves several critical steps to ensure effective access and treatment of the cranial nerves. The steps are as follows:

• Step 1: Patient Positioning - The patient is placed in a supine position, which allows for optimal access to the surgical site. The head is then secured in a Mayfield clamp to prevent movement during the procedure.
• Step 2: Incision - A curvilinear skin incision is made behind the ear. Care is taken to avoid injury to the greater and lesser occipital nerves during this step, as these nerves are located in close proximity to the surgical site.
• Step 3: Bone Removal - A small section of the skull is removed using a cutting bur. This step is essential to gain access to the underlying dura mater and cranial nerves.
• Step 4: Dura Incision and Decompression - The dura mater is incised, allowing for the decompression of the posterior fossa. This step is crucial for exposing the cerebellopontine angle, where the cranial nerves are located.
• Step 5: Cranial Nerve Sectioning - In this step, one or more cranial nerves are sectioned (cut) to alleviate the symptoms caused by their compression. This is the primary focus of the procedure and is performed to treat conditions such as severe vertigo.
• Step 6: Closure - After the cranial nerve sectioning is completed, the dura is reapproximated. The exposed mastoid air cells are sealed with bone wax to prevent complications. Gelfoam is placed over the dura, followed by Gelfilm, and the surgical site is closed in layers using muscle, fascia, and skin.

3. Post-Procedure

Following the completion of the procedure, patients are typically monitored for any immediate complications. Post-operative care may include pain management and monitoring for symptoms related to the cranial nerves that were sectioned. Recovery time can vary based on individual patient factors and the extent of the surgery performed. It is essential for healthcare providers to provide detailed post-operative instructions to ensure proper healing and to address any potential complications that may arise after the procedure.