CPT® Code 61320

A supratentorial craniectomy or craniotomy is a surgical procedure performed to drain an intracranial abscess located in the supratentorial region of the brain. The term "supratentorial" refers to the area above the tentorium cerebelli, which is a fold of dura mater that separates the cerebrum from the cerebellum. An intracranial abscess is defined as a localized collection of pus that can occur within the cerebrum, subdural space, or extradural space, often resulting from infection or other pathological processes. The procedure involves either a craniectomy, where a portion of the skull is removed, or a craniotomy, where the skull is opened to access the abscess. During a craniectomy, the surgeon creates scalp flaps and drills burr holes in the skull, followed by cutting the bone between these holes to raise a bone flap, which may be temporarily or permanently removed. In contrast, a craniotomy involves incising the scalp and lifting both the scalp and bone flaps to expose the abscess. The approach taken depends on the abscess's location and whether it is situated in an eloquent area of the brain, which includes critical regions responsible for functions such as movement, language, and vision. If the abscess is located in a non-eloquent region, the surgeon can dissect the abscess wall from the surrounding brain tissue to remove the lesion. However, if the abscess is in an eloquent area, an operative microscope is utilized to carefully visualize and preserve important blood vessels. The abscess wall is then opened to create a pouch, allowing for the aspiration of pus, followed by irrigation of the cavity with saline solution. After the procedure, the dura mater is closed to prevent cerebrospinal fluid leakage, and the bone flap is secured back in place. The surgical site is then closed in layers, ensuring proper healing and recovery.