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CPT®
61480

CPT® Code 61480
Deleted

Official Description

for mesencephalic tractotomy or pedunculotomy

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Mesencephalic tractotomy, also known as pedunculotomy, is a neurosurgical procedure that involves the division or cutting of a specific nerve tract within the brain, particularly targeting the midbrain region. This intervention is primarily indicated for the management of intractable pain, especially pain that arises from conditions such as head and neck cancer, which is classified as nociceptive pain. The procedure aims to alleviate unilateral intractable pain by disrupting the spinothalamic tract, a critical pathway responsible for transmitting pain signals from the spinal cord to the brain. Traditionally, open tractotomy techniques have been associated with significant morbidity, including complications such as deafness, gaze palsy, and dysaesthesia. Due to these risks, less invasive alternatives, such as stereotactic tractotomy, have gained preference in clinical practice. The mesencephalon, or midbrain, is accessed through a suboccipital craniotomy, which requires careful positioning of the patient and meticulous surgical technique to ensure optimal exposure and minimize potential complications.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The mesencephalic tractotomy or pedunculotomy is indicated for patients experiencing severe, unilateral intractable pain that is not responsive to conventional pain management therapies. This procedure is particularly relevant for individuals suffering from:

  • Intractable Pain Pain that persists despite treatment efforts, often associated with conditions such as head and neck cancer.
  • Nociceptive Pain Pain resulting from the activation of pain receptors due to tissue injury or disease, specifically in the context of malignancies.

2. Procedure

The procedure of mesencephalic tractotomy involves several critical steps to ensure effective access to the midbrain and successful execution of the tractotomy.

  • Patient Positioning The patient is positioned in a sitting posture to facilitate optimal access to the midbrain. This positioning is crucial for the surgeon to perform the procedure effectively.
  • Head Stabilization The head is secured in a neutral position using tongs or a Mayfield head holder, which prevents movement during the surgical intervention and enhances precision.
  • Incision and Exposure A midline incision is made over the lower aspect of the skull, allowing for exposure of the occiput. This incision is essential for accessing the underlying structures of the brain.
  • Creation of Burr Holes Burr holes are drilled in the suboccipital region to facilitate the next steps of the procedure. These holes are critical for the subsequent creation of a bone flap.
  • Bone Flap Creation A saw is utilized to connect the burr holes, creating a bone flap that extends to the posterior margin of the foramen magnum. This step is vital for providing adequate access to the mesencephalon.
  • Elevation of Bone Flap The bone flap is carefully elevated to expose the mesencephalon, allowing the surgeon to visualize and access the targeted nerve tract.
  • Sectioning of the Spinothalamic Tract The spinothalamic tract, which is the primary ascending pathway for pain transmission, is sectioned unilaterally. This action is intended to produce hemi-analgesia, effectively reducing pain perception on one side of the body.
  • Dura Closure After the tractotomy is completed, the dura mater is reapproximated to protect the underlying brain structures.
  • Application of Gelfoam and Closure Gelfoam is placed over the dura to promote healing, followed by Gelfilm. The surgical site is then closed in layers, including muscle, fascia, and skin, ensuring proper healing and minimizing the risk of infection.

3. Post-Procedure

Post-procedure care for patients undergoing mesencephalic tractotomy includes monitoring for potential complications and managing recovery. Patients are typically observed for signs of neurological deficits, infection, or other adverse effects. Pain management strategies may be adjusted based on the effectiveness of the procedure. The expected recovery period may vary, and follow-up appointments are essential to assess the patient's pain levels and overall neurological function. Rehabilitation may be necessary to support recovery and improve quality of life following the surgery.
Short Descr INCISE SKULL FOR SURGERY
Medium Descr CRNEC SUBOCPTL MESENCEPHAL TRCOTOMY/PEDUNCULOTMY
Long Descr for mesencephalic tractotomy or pedunculotomy
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE Not applicable/unspecified.
CCS Clinical Classification 1 - Incision and excision of CNS
Date
Action
Notes
2019-01-01 Deleted Code deleted
Pre-1990 Added Code added.
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