# Encephalodurangiomyangiosis (EDAM) procedure



## gardnertel123 (Jan 10, 2011)

Has anyone coded one of these before?  This is a vascularization procedure for internal carotid artery stenosis.  

The patient was taken to the operating room and placed in the supine position with head to the left on horseshoe headrest.  Doppler was used to track the course of the superficial temporal artery and posterior branch which was marked on the skin.  The patient was then prepped and draped in the standard sterile fashion. 
Skin was opened and meticulous dissection accomplished to liberate the STA with a perivascular cufff.  This was done with dopplerable pulses maintained throughout the procedure.
The STA was retracted posteriorly and protected.   The temporalis muscle was opened and cranium explosed.  Craniectomy was performed with the placement of two burr holes and the dura was opened in a linear fashion.
The STA and its cuff were tacked to the dura.  She had very friable arachnoid space and brain and the STA was laid on top in direct contact.  Muscle flaps were tacked down bilaterally to the dura and covering the vascular contact as well.

At the conclusion of the procedure, saline irrigation was applied. We insured that there was no further epidural bleeding bone wax was used as needed.  A 2.0 vicryl scalp closure was perfomed with the use of 3.0vicryl subcutaneously and a subcuticular closure followed by the use of 4.0 polysorb on the scalp.   The incision was then dressed after the scalp was cleaned with bacitracin.  All instrument counts were correct, and the patient was taken to recovery in stable condition.


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