I need the CPT for this procedure. The patient is post op from 62164 Neuroendoscopy, intracranial: with excision of brain tumor.
POSTOPERATIVE DIAGNOSIS:
Postop right-sided craniotomy with pneumocephalus.
PROCEDURE PERFORMED:
Re-exploration craniotomy and sealing of the right frontal sinus defect.
PROCEDURE:
After the risks, benefits and alternatives were explained to the patient and family, written informed consent was obtained. The patient brought in the operating room on a gurney and general endotracheal anesthesia was then induced. After the ET tube and lines were secured, the patient's head was fixed in a Mayfield skull clamp. The surgical site area was then shaved, prepped and draped in the sterile fashion. After the draping was done, the previous incision was opened in incremental fashion. Raney clips were applied for hemostasis. The flap was then reflected forward and using the Synthes craniofacial system, the screws were removed from the plating system holding onto the intact part of the skull. The flap was then elevated. We noticed significant pneumocephalus, with the dura
depressed down. We did not notice an obvious leakage from the frontal sinus repair site where we placed Durepair and DuraGen in the past. But we revised that, open the frontal sinus up wider, and laid bone wax into the frontal sinus which was visualized. We then placed temporalis muscle, which was harvested locally, over this, and DuraGen over this, and dura Seal was then applied.
We then placed multiple dural tack-up sutures and made a multiple holes using AM8 in the bone. The dural tack-up sutures were then pulled up, tacked up through these multiple holes. The bone flap was replaced using the Synthes craniofacial system. The wound was then irrigated with copious amounts of saline and closure was done in layers using 2-0 Vicryl for the temporalis muscle and galea, and staples for the skin. There were no intraoperative complications. Sponge and needle counts x2 at the end of procedure correct.
POSTOPERATIVE DIAGNOSIS:
Postop right-sided craniotomy with pneumocephalus.
PROCEDURE PERFORMED:
Re-exploration craniotomy and sealing of the right frontal sinus defect.
PROCEDURE:
After the risks, benefits and alternatives were explained to the patient and family, written informed consent was obtained. The patient brought in the operating room on a gurney and general endotracheal anesthesia was then induced. After the ET tube and lines were secured, the patient's head was fixed in a Mayfield skull clamp. The surgical site area was then shaved, prepped and draped in the sterile fashion. After the draping was done, the previous incision was opened in incremental fashion. Raney clips were applied for hemostasis. The flap was then reflected forward and using the Synthes craniofacial system, the screws were removed from the plating system holding onto the intact part of the skull. The flap was then elevated. We noticed significant pneumocephalus, with the dura
depressed down. We did not notice an obvious leakage from the frontal sinus repair site where we placed Durepair and DuraGen in the past. But we revised that, open the frontal sinus up wider, and laid bone wax into the frontal sinus which was visualized. We then placed temporalis muscle, which was harvested locally, over this, and DuraGen over this, and dura Seal was then applied.
We then placed multiple dural tack-up sutures and made a multiple holes using AM8 in the bone. The dural tack-up sutures were then pulled up, tacked up through these multiple holes. The bone flap was replaced using the Synthes craniofacial system. The wound was then irrigated with copious amounts of saline and closure was done in layers using 2-0 Vicryl for the temporalis muscle and galea, and staples for the skin. There were no intraoperative complications. Sponge and needle counts x2 at the end of procedure correct.