CPT® Code 61557

1. Indications

The procedure described by CPT® Code 61557 is indicated for the treatment of craniosynostosis, particularly when a bifrontal bone flap is required. The following conditions may warrant this surgical intervention:

• Craniosynostosis - A condition where one or more cranial sutures close prematurely, leading to potential complications such as increased intracranial pressure and abnormal head shape.
• Associated Syndromes - Conditions such as Crouzon, Apert, Carpenter, Chotzen, or Pfeiffer syndrome, which may present with craniosynostosis alongside other congenital abnormalities.
• Impaired Brain Development - Situations where the premature closure of sutures is affecting brain growth and development, necessitating surgical intervention to alleviate pressure.

2. Procedure

The procedure for CPT® Code 61557 involves several critical steps to effectively address craniosynostosis through the creation and elevation of a bifrontal bone flap:

• Step 1: Incision and Flap Elevation - A skin incision is made over the frontal bone, and a scalp flap is elevated to expose the underlying skull. This initial step is crucial for gaining access to the cranial structures that need to be addressed.
• Step 2: Skull Exposure and Marking - Once the scalp flap is elevated, the skull is exposed, and the surgeon marks the areas where bone cuts will be made. This careful planning is essential to ensure that the bone flap can be properly shaped and repositioned.
• Step 3: Drilling Burr Holes - Burr holes are drilled along the lines of the planned bone cuts. These holes serve as entry points for the subsequent bone cuts and are critical for the precision of the procedure.
• Step 4: Making Bone Cuts - Using a craniotome or saw, the surgeon makes bone cuts that connect the burr holes. This step allows for the creation of the bifrontal bone flap, which will be elevated during the procedure.
• Step 5: Elevating the Bone Flap - The bone flap is carefully elevated to provide access to the underlying brain tissue. This elevation is necessary to relieve pressure and allow for the proper reshaping of the skull.
• Step 6: Repositioning the Bone - The bone flap is repositioned as needed to facilitate normal brain growth and skull remodeling. This step is critical to ensure that the skull can develop appropriately post-surgery.
• Step 7: Securing the Bone Flap - The repositioned bone flap is secured using miniplates and screws as necessary. This fixation is important for maintaining the stability of the bone flap during the healing process.
• Step 8: Closing the Incisions - The incisions are closed in layers to promote optimal healing. Proper closure techniques are essential to minimize complications and support recovery.
• Step 9: Post-Operative Care - After the procedure, the infant is placed in a custom-made helmet designed to help reshape the skull as bone growth occurs. This post-operative care is vital for achieving the desired outcomes in skull shape and brain development.

3. Post-Procedure

Post-procedure care following the craniotomy for craniosynostosis involves monitoring the infant for any signs of complications, such as infection or excessive swelling. The infant will typically be placed in a custom-made helmet that aids in the reshaping of the skull as it heals and grows. Regular follow-up appointments are essential to assess the healing process and ensure that the skull is developing correctly. Parents or caregivers will receive instructions on how to care for the surgical site and what signs to watch for that may indicate complications. Overall, the expected recovery involves gradual improvement in head shape and brain function as the infant grows.