CPT® Code 61026

Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment

A ventricular puncture is a medical procedure that involves accessing the ventricles of the brain, which are fluid-filled cavities, through a previously established entry point such as a burr hole, fontanelle, suture, or an implanted ventricular catheter or reservoir. This procedure is typically performed to either diagnose or treat various neurological conditions. The process begins with preparing the scalp, which may involve cutting hair or shaving the area over the intended puncture site to ensure a sterile environment. When accessing the ventricles through a burr hole, fontanelle, or suture, a spinal needle is carefully advanced through the skin and into the ventricle. The stylet of the needle is then removed to allow cerebrospinal fluid (CSF) and blood to be drained, which can help relieve pressure within the cranial cavity. After the necessary fluid is withdrawn, the stylet is replaced, the needle is removed, and a dressing is applied to the puncture site to promote healing and prevent infection. In cases where the puncture is made through an implanted ventricular catheter or reservoir, the needle is inserted at a specific angle (30 to 45 degrees) into the reservoir bladder. Similar to the previous method, CSF and blood are drained, and as the intracranial pressure decreases, the flow rate of the fluid will slow down. Once the pressure has been adequately reduced, the needle is withdrawn, and firm pressure is applied to the site to ensure that drainage has ceased. This procedure can also involve the injection of medication or other substances, such as gas, contrast media, dye, or radioactive material, into the ventricle simultaneously with the withdrawal of CSF. The head may be rotated to help disperse the injected substance throughout the ventricular system. If the injection is performed for the purpose of ventriculography, any necessary radiographs must be reported separately. This comprehensive approach allows for both diagnostic and therapeutic interventions in managing conditions affecting the brain's ventricular system.