Neurosurgery Coding Alert

Your surgeon may attempt a subtemporal decompression in a patient with increased intracranial hypertension. Two common indications for this procedure are pseudotumor cerebri and the slit ventricular syndrome. 

What is pseudotumor cerebri? Pseudotumor cerebri is a neurological disorder with signs and symptoms of increased intracranial pressure. Your surgeon will make this diagnosis after ruling out intracranial tumors and other causes for increased intracranial pressure after doing a brain scan and lumbar puncture. Pseudotumor cerebri is also known as idiopathic intracranial hypertension or benign intracranial hypertension. “This can be associated with papilledema and visual loss.  Although most patients respond to medications and weight loss, surgical treatments are sometime required, particularly in the setting of progressive visual loss,” says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

What is slit ventricular syndrome? Slit ventricular syndrome (SVS) is a condition where a patient with shunts experiences repeated headaches. In case of overdrainage, the headaches are positional and may be relieved by lying down. There are diverse pathophysiologies associated with SVS. Patients with SVS show very small ventricles on MRI or CT scans. Symptoms typically occur years after shunt placement or shunt revision and the shunt is found to be barely functioning in such patients. The symptoms can occur in episodes. Besides headaches, the other symptoms are lethargy, nausea, and vomiting.   “Sometimes shunt externalization with gradual “retraining” of the ventricles can be achieved, avoiding the need for other invasive treatments,” Przybylski says.