CPT® Code 78650

1. Indications

The procedure for cerebrospinal fluid leakage detection and localization is indicated for the following conditions:

• CSF Rhinorrhea - This condition involves the leakage of cerebrospinal fluid from the nose, which may occur due to trauma, surgical complications, or spontaneous defects.
• CSF Otorrhea - This refers to the leakage of cerebrospinal fluid from the ear, often resulting from similar causes as CSF rhinorrhea.
• Suspected Meningeal Fistulas - The procedure is utilized when there is a suspicion of abnormal connections between the CSF spaces and the surrounding structures, which can lead to leakage.
• Post-Surgical Evaluation - Following neurosurgical procedures, this test may be performed to assess for potential CSF leaks that could complicate recovery.

2. Procedure

The procedure for detecting and localizing cerebrospinal fluid leakage involves several key steps:

• Intrathecal Injection - The first step involves the administration of a radiolabeled isotope tracer directly into the cerebrospinal fluid space via an intrathecal injection. This tracer is essential for visualizing the flow of CSF and identifying any leaks.
• Patient Positioning - After the injection, the patient is carefully positioned on the imaging table. The positioning is critical to ensure that the gamma camera can effectively capture the emissions from the tracer in the area of interest.
• Gamma Camera Scanning - A gamma camera is placed over the targeted area, and scanning is performed at specific intervals. This scanning process allows for the detection of radioactive energy emitted by the tracer as it moves through the CSF pathways.
• Image Interpretation - The emitted radioactive energy is converted into images that depict the distribution of the tracer. A physician then interprets these images to identify the presence and location of any CSF leaks.
• Report Generation - Finally, the physician compiles a written report summarizing the findings of the study, which is crucial for guiding further clinical management and treatment decisions.

3. Post-Procedure

After the cerebrospinal fluid leakage detection and localization procedure, patients may be monitored for any immediate adverse effects related to the intrathecal injection. It is important to observe for signs of complications such as headache, infection, or neurological changes. Patients are typically advised to rest and may be instructed to avoid strenuous activities for a short period following the procedure. The physician will review the findings from the imaging study and discuss the results with the patient, outlining any necessary follow-up actions or additional diagnostic steps based on the report's conclusions.