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MP 7.01.43 (Archived) Adrenal-to-Brain Transplantation

Medical Policy
Section
Surgery
 
Original Policy Date
3/31/96
Last Review Status/Date
Archived/2:2011
Issue
2:2003
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

The transplantation of adrenal medullary tissue to the corpus striatum is intended to ameliorate the motor and postural dysfunctions of Parkinson’s disease. Striatal dopamine is depleted in Parkinson’s disease patients. The rational for the procedure is that adrenal tissue may restore dopamine activity in the corpus striatum. Adrenal-to-brain transplantation can involve either autografts or fetal allografts.

Autotransplantation entails simultaneous adrenalectomy and craniotomy with subsequent implantation of adrenal medullary tissue. Adrenal tissue is usually implanted in fragments into the caudate nucleus at the margin of the lateral ventricle, such that the tissue is exposed to cerebrospinal fluid (CSF). Tissue fragments can be anchored in place with surgical staples or with Gelfoam®. Besides the caudate nucleus, the putamen has also been used as an implantation site. Open microsurgical insertion of the tissue has been used in addition to stereotactic localization and implantation using a cannula.

Allografting involves harvesting adrenal tissue from an aborted fetus. The surgical techniques are the same as autotransplantation, with the exception of the adrenalectomy.


Policy

Adrenal-to-brain transplantation with autograft or fetal allograft is considered investigational.


Policy Guidelines

No applicable information


Benefit Application

No applicable information


Rationale

A search of the literature was completed through the MEDLINE database for the period of January 1992 through December 1995. The search strategy focused on references containing the following Medical Subject Headings:

– Adrenal (textword)
 
– Parkinson’s disease (explode)
 
– Tissue Transplantation (explode)

Research was limited to English-language journals on humans.

See also:

Technology Evaluation and Coverage 1988: p. 389
 
TEC Assessments: 1995: Tab 1
 
Fetal Mesencephalic Transplantation for the Treatment of Parkinson’s Disease; Surgery Section; Policy Number 7.01.10

 

Codes

Number

Description

CPT  No code   
ICD-9 Procedure  No code 
ICD-9 Diagnosis    Investigational for all codes 
HCPCS  S2103  Adrenal tissue transplant to brain 
Type of Service  Surgery 
Place of Service  Inpatient 


Index

Adrenal-to-Brain transplantation
Parkinson’s disease, adrenal-to-brain transplantation
Transplantation, adrenal-to-brain


Policy History

Date Action Reason
03/31/96 Add to Surgery section New policy
04/15/02 Replace policy Policy reviewed by consensus; new review date only
07/17/03 Replace policy Policy no longer scheduled for review
2/2011 Policy archived  


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