CPT® Code 61697

The procedure described by CPT® Code 61697 involves the surgical intervention for a complex intracranial aneurysm located within the carotid circulation, utilizing an intracranial approach. A complex intracranial aneurysm is characterized by specific features that complicate its treatment, including a size greater than 15 mm, the presence of calcification at the neck of the aneurysm, and the involvement of normal blood vessels within the aneurysm neck. Additionally, if the surgical procedure necessitates temporary occlusion of the blood vessel, trapping of the aneurysm, or the use of cardiopulmonary bypass to achieve successful treatment, the aneurysm is classified as complex. The surgical approach is determined by the precise location of the aneurysm, which may involve accessing the aneurysm through the interhemispheric fissure or the pterion. The procedure begins with an incision through the skin and subcutaneous tissue, followed by the removal of the overlying bone through a craniectomy. Once the dura mater is opened, the arachnoid membrane is carefully nicked, and cerebrospinal fluid may be drained to enhance visibility and access to the internal carotid or vertebrobasilar artery. The surgeon then identifies and separates the artery from the arachnoid membrane to expose the aneurysm. Treatment options for the aneurysm include clipping and resecting the mass lesion, followed by vessel reconstruction through direct repair with a bypass graft. Alternatively, if there is sufficient collateral circulation, the aneurysm may be trapped, with clips applied above and below the lesion to achieve complete occlusion.