CPT® Code 61605

Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; extradural

The CPT® Code 61605 refers to the surgical procedure involving the resection or excision of neoplastic (tumorous), vascular, or infectious lesions located in the infratemporal fossa, parapharyngeal space, and petrous apex. This procedure is performed in the extradural space, which is the area between the periosteal dura mater that is attached to the skull and the endosteal dura mater that protects the brain. The approach to access these areas is separately reportable, indicating that it may require additional coding for the surgical access method used. During the procedure, the surgeon explores the extradural space and removes any identified lesions as necessary. It is important to note that this code specifically pertains to extradural procedures; for intradural procedures, a different code (CPT® Code 61606) is utilized, which involves entering the endosteal dura and performing further resection or excision. The procedure requires careful handling of critical anatomical structures, including the maxillary artery and the trigeminal nerve, to avoid complications. The surgical approach may also involve examining and potentially resecting the cartilaginous Eustachian tube, as well as the pterygoid muscles, while preserving or ligating the pterygoid venous plexus. The procedure may necessitate drilling or chiseling the lateral and medial pterygoid plates and the petrous apex to effectively remove lesions. Post-surgical care includes repairing any dural defects to ensure a watertight seal and prevent cerebrospinal fluid leakage, which may involve suturing or using graft materials. The procedure concludes with the wiring of the zygomatic arch, layered suturing of the incision, and possible closure of the skin with staples.