The use of a fat graft is recommended as a rapid, effective means of prevention and repair of CSF leaks following spinal surgery. Both postoperative CSF leaks were controlled by applying additional skin sutures. There was one case of postoperative CSF leakage in 140 cases in which intradural exploration for tumor or other lesions was undertaken. With one exception, 27 dural tears noted during 1650 spinal procedures were successfully repaired using this technique. Dural suture lines following spinal intradural exploration are prophylatically protected from CSF leakage in the same manner. For ventral dural tears (associated with procedures in which disc material is excised), fat is packed into the disc space to seal off the ventral dural leak. Fibrin glue is spread on the surface of the fat and is further covered with Surgicel or Gelfoam. This procedure prevents CSF from seeping around the fat, which may be tacked to the dura with a few sutures. In this paper the author reports his experience with using fat grafts for the prevention or repair of CSF leaks and proposes a technique in which a large sheet of fat, harvested from the patient's subcutaneous layer, is used to cover not only the dural tear(s) but all of the exposed dura and is tucked into the lateral recess. Fat is an ideal sealant because it is impermeable to water. ![]() ![]() A midline dural tear in the spine is readily repaired by direct application of sutures however, far-lateral or ventral dural tears are problematic. Please accept the terms and conditions for use of the Part B News web site.✓ Cerebrospinal fluid (CSF) leaks are relatively common following spinal surgery. You may not use any trademark displayed on the site without the written permission of DecisionHealth or its respective owners. The trademarks, service marks and logos of DecisionHealth, its product-specific brands, or others used on this are the property of DecisionHealth or its respective owners. Use of this web site evidences agreement with these restrictions. This does not convey permission for commercial use or for making multiple copies for uses internal or external. Users are granted the right to print out any article and/or newsletter found on the site for individual, personal use. Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Do not duplicate or redistribute in any form. were forced to choose between four types of CPT codes which. Therefore, the user assumes full liability for use of the information on this site, and understands and agrees that DecisionHealth is neither responsible nor liable for any claim, loss, or damage resulting from its use.Ĭopyright ©2010 DecisionHealth. While we strive to ensure that the information is accurate, we make no representation of its accuracy, completeness or appropriateness for a particular purpose. Part B News is a service of DecisionHealth. Enterprise wide licenses also are available. ![]() Multiple subscriptions can be purchased for one or many locations by calling an account representative at 1-80. Do not use codes such as 61618 or 61619 (secondary repair of cerebrospinal fluid (CSF) leak codes) as a comparison or base code for the unlisted code billed. Subscribers to Part B News are purchasing access to an online service for a defined subscription period.Įach subscription is for one user. Repair of the Dura/Closure Closure of the dura is included in the unlisted procedure code reported just as it is part of the usual skull base surgery definitive procedure codes (e.g., 61601). To learn more about subscribing to Part B News, visit the DecisionHealth store right now. Our $25,000 guarantee ensures that your subscription will pay for itself at least 50 times over or we will refund the full year’s subscription fee. Plus, through this web site and its forums, you plug into a community of peers who'll share exactly what's working and what's not as questions arise in your practice.Ī subscription to Part B News is the physician practice manager’s best tool to ensure that your practice collects every dollar it deserves. When you subscribe to Part B News, you get step-by-step instructions from the nation's leading physician practice management experts on how to not just survive – but thrive – from changes at CMS and private payers. Part B News is how you level the playing field and take control of the financial impact that the changing health care landscape has on your practice. For site license inquiries call: 1-855-CALL-DH1 Need multi-user access? Ensure uninterrupted individual access and maximum coding productivity for your whole team. Not a subscriber? Start accessing the article you’re seeking right away plus weekly, physician practice-specific news, analysis, guidance and specific tools that enable your practice to stay compliant and profitable during times of increased regulatory scrutiny. You must log in to view the content you requested.
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