CPT® Code 61591

Infratemporal post-auricular approach to middle cranial fossa (internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, infratemporal fossa) including mastoidectomy, resection of sigmoid sinus, with or without decompression and/or mobilization of contents of auditory canal or petrous carotid artery

The CPT® Code 61591 describes a complex surgical procedure known as the infratemporal post-auricular approach to the middle cranial fossa. This approach is utilized to access various anatomical structures and lesions located in critical areas such as the internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, and infratemporal fossa. The procedure involves a meticulous incision that begins in the temporal region, extending behind the ear over the mastoid bone and down into the neck. This incision is strategically designed to provide optimal access and control over the internal carotid artery, which is essential for the safe navigation of neurovascular structures during surgery. During the operation, a scalp flap is elevated, and the temporalis muscle is carefully detached from the temporal fossa to facilitate access to the underlying structures. A mastoidectomy is performed, which involves the removal of mastoid air cells to enhance visibility and access to the middle cranial fossa. Additionally, the resection of the sigmoid sinus may be necessary to further expose the surgical field. It is important to note that the middle ear may be sacrificed during this approach, depending on the specific requirements of the procedure. The facial nerve, a critical structure in the vicinity, is typically skeletonized and protected throughout the operation; however, if the tumor has invaded the facial nerve, resection may be unavoidable. A temporal craniotomy is then executed, with the precise placement of osteotomies determined by the lesion's location. The frontal lobe is retracted to allow for further dissection, and soft tissues are meticulously dissected off the infratemporal skull base. If the middle ear remains intact, the auditory canal may be decompressed and mobilized, along with the petrous carotid artery, to ensure that all neurovascular structures are identified and preserved before the dissection of the lesion commences. This comprehensive approach underscores the complexity and precision required in performing this surgical intervention.