CPT® Code 61314

An infratentorial craniectomy or craniotomy is a surgical procedure performed to evacuate a hematoma located in the infratentorial region of the brain, which is situated below the tentorium cerebelli. The tentorium cerebelli is a fold of dura mater that separates the cerebellum from the cerebrum, specifically the frontal and occipital lobes. This procedure addresses two types of hematomas: extradural and subdural. An extradural hematoma occurs when there is a collection of blood between the inner table of the skull and the dural membrane, often resulting from trauma. In contrast, a subdural hematoma is characterized by blood accumulation between the dural and arachnoid membranes, typically due to the tearing of veins during head injury. The surgical approach involves creating scalp flaps and making burr holes in the skull. The bone between these burr holes is then cut, allowing for the elevation of a bone flap, which may be temporarily or permanently removed. In the case of a craniotomy, the scalp is incised, and both scalp and bone flaps are raised to access the hematoma. If a subdural hematoma is present, the dural flaps are also elevated. The hematoma is evacuated using specialized instruments such as biopsy forceps, gentle suction, and irrigation techniques. After the evacuation, the dural flap is carefully repositioned over the brain and secured with sutures to prevent cerebrospinal fluid leakage. A temporary drain may be placed if residual fluid is present. Finally, the bone flap is reattached and secured, and the scalp is closed in layers. This procedure is critical for alleviating pressure on the brain and preventing further complications associated with hematomas.