|MP 7.01.43||(Archived) Adrenal-to-Brain Transplantation|
|Original Policy Date
|Last Review Status/Date
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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.
Adrenal-to-brain transplantation with autograft or fetal allograft is considered investigational.
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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.
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
|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|
Parkinson’s disease, adrenal-to-brain transplantation
|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|