CPT® Code 61450

The procedure described by CPT® Code 61450 refers to a craniectomy performed in the subtemporal region, specifically targeting the sensory root of the Gasserian ganglion, which is also known as the trigeminal ganglion. This ganglion is a critical component of the trigeminal nerve (cranial nerve V), responsible for transmitting sensory information from the face to the brain. The Gasserian ganglion is situated within Meckel's cave, a cavity in the dura mater located near the apex of the petrous portion of the temporal bone. The primary purpose of this surgical intervention is to alleviate pain symptoms that arise from compression of the Gasserian ganglion. During the procedure, a small curvilinear incision is made behind the ear to access the area. The temporal muscle is then divided, and its fibers are carefully separated from the underlying bone to expose the temporal fossa. A small section of the temporal bone is excised to gain access to the sensory root of the Gasserian ganglion. Various techniques may be employed during the procedure, including the division of nerve fibers, the use of a balloon to temporarily compress the nerve root, or the dissection of vascular structures that may be compressing the trigeminal nerve. The latter technique, known as microvascular decompression, is the most frequently performed method. In this approach, blood vessels are meticulously dissected away from the nerve, and a Teflon pad is placed between the nerve and the blood vessels to prevent further compression. After the necessary interventions are completed, the excised portion of the temporal bone is replaced and secured with wire sutures, followed by the closure of the overlying tissues in layers.