CPT® Code 61322

Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy

A decompressive craniectomy or craniotomy is a surgical procedure aimed at alleviating increased intracranial pressure, known as intracranial hypertension. This procedure can be performed with or without duraplasty, which is a technique used to repair or augment the dura mater, the outermost layer of the protective covering of the brain. The primary goal of this intervention is to relieve pressure on the brain without the need for evacuation of any associated intraparenchymal hematoma, which is a collection of blood within the brain tissue itself, and without performing a lobectomy, which involves the removal of a portion of the brain. In a craniectomy, the surgeon creates scalp flaps and drills several burr holes in the skull. The bone between these holes is then cut using a specialized saw or craniotome, allowing for the removal of a bone flap, which can be either temporarily or permanently excised. Conversely, a craniotomy involves making an incision in the scalp and lifting both the scalp and the bone flaps to access the brain. During this procedure, the dura is opened, and if necessary, a duraplasty is performed to expand the dura mater, facilitating the decompression of the brain. This may involve the use of various graft materials, such as an autologous galeal flap graft, a cultured dermal graft, or a synthetic patch graft. To ensure the integrity of the cerebrospinal fluid barrier, the dura and/or the dural graft is meticulously sutured. A drain may be placed to manage any excess fluid. After the procedure, the bone flap is typically repositioned over the dura and secured with steel sutures. In some cases, if significant cerebral swelling is anticipated, the bone flap may be excised and preserved in an abdominal pocket or a bone bank until the swelling subsides. This procedure is critical in managing conditions that lead to elevated intracranial pressure, thereby protecting brain function and preventing further neurological damage.