CPT® Code 61608

1. Indications

The procedure described by CPT® Code 61608 is indicated for the treatment of various lesions located in the parasellar area, cavernous sinus, clivus, or midline skull base. These indications may include:

• Neoplastic Lesions - Tumors that may be benign or malignant, requiring surgical intervention to remove or reduce their size.
• Vascular Lesions - Abnormal blood vessel formations that may pose a risk to surrounding structures or lead to complications.
• Infectious Lesions - Infections that affect the aforementioned areas, necessitating excision to prevent further complications or spread of infection.

2. Procedure

The procedure involves several critical steps to ensure the effective resection or excision of the lesion:

• Accessing the Surgical Site - The surgeon begins by accessing the parasellar area through a separately reportable approach, typically via the sella turcica, which is the central area of the sphenoid bone. This area is covered by dura and houses important structures such as the hypothalamus, optic chiasm, and pituitary gland.
• Dissection and Exposure - Using either blunt or sharp dissection techniques, the dural tent is opened to gain access to the cavernous sinus. This area contains a network of blood vessels and cranial nerves, and care is taken to preserve the carotid arteries and cranial nerves III, IV, VI, and V during the procedure.
• Resection of the Lesion - The lesion is then excised en bloc whenever possible, or it is debulked to the greatest extent feasible. The surgical area is thoroughly checked for any signs of bleeding to ensure hemostasis.
• Dural Repair - After the lesion has been removed, the dural defect is repaired. This may involve primary closure using sutures or the interposition of graft material, such as autologous pericranium or synthetic materials like acellular human dermis or collagen matrix, to create a watertight seal and prevent cerebrospinal fluid (CSF) leakage.
• Closure of Extradural Deficits - Any extradural deficits may be filled with autologous graft material, such as fascia, fat, or bone, to restore structural integrity.
• Final Closure - The skull defect is then closed using the patient’s excised bone, cadaver bone graft, or a metal plate. The incision is sutured in layers, and the skin may be closed using staples to complete the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications, particularly signs of cerebrospinal fluid leakage or infection. The surgical site will be assessed for proper healing, and the patient may require follow-up imaging studies to evaluate the success of the resection. Pain management and rehabilitation may also be part of the recovery process, depending on the extent of the surgery and the patient's overall health status.