The clinical significance and optimal timing of postoperative computed tomography following cranial surgery

Clinical article

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Object

This study was conducted to evaluate the value of postoperative CT scans in determining the probability of return to the operating room (OR) and the optimal time to obtain such scans to determine the effects of surgery.

Methods

Between January and December 2006 (12 months), all postoperative head CT scans obtained for 3 individual surgeons were reviewed. Scans were divided into 3 groups, which were determined by the preference of each surgeon: Group A (early scans—scheduled between 0 and 7 hours); Group B (delayed scans—scheduled between 8 and 24 hours); and Group C (urgent scans—ordered because of a new neurological deficit). The initial scans were reviewed and analyzed in 2 different fashions. The first was to analyze the efficacy of the scans in predicting return to the OR. The second was to determine the optimal time for obtaining a scan. The second analysis was a review of serial postoperative scans for expected versus unexpected findings and changes in the acuity of these findings over time.

Results

In 251 (74%) of 338 cases, the patients had postoperative head CT scans within 24 hours of surgery. Analysis 1 determined the percent of patients returning to the OR for emergency treatment based on postoperative scans: Group A (early)—133 patients, with 0% returning to the OR; Group B (delayed)—108 patients, with 0% returning to the OR; and Group C (urgent)—10 patients, with 30% returning to the OR (p < 0.05). Analysis 2 determined the optimal timing of postoperative scans and changes in scan acuity: Group A (early scan) had an 11% incidence of change in acuity on subsequent scans. Group B (delayed scan) had a 3% incidence of change in acuity on follow-up scans (p < 0.05).

Conclusions

Routine postoperative scans at 0–7 hours or at 8–24 hours are not predictive of return to the OR, whereas patients with a new neurological deficit in the postoperative period have a 30% chance of emergency reoperation based on CT scans. In addition, early postoperative scans (0–7 hours) fail to predict CT changes, which might evolve over time and may influence postoperative medical management.

Abbreviations used in this paper: OR = operating room; SDH = subdural hematoma.

Article Information

Address correspondence to: Thomas C. Origitano, M.D., Ph.D., Department of Neurological Surgery, Loyola University Medical Center, 2156 1st Avenue, Maywood, Illinois 60153. email: torigit@lumc.edu.

Please include this information when citing this paper: published online December 18, 2009; DOI: 10.3171/2009.11.JNS081048.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A: Axial head CT obtained at 0–7 hours after surgery. In this patient a metastatic melanoma to the left temporal area was removed. The patient had normal results on neurological examination postoperatively. B: Axial head CT obtained after the patient had a sudden change on neurological examination. The head CT reveals a hemorrhage into the tumor bed. C: Axial head CT obtained at 0–7 hours after the second surgery. This patient had the cranial bone removed as well as the hematoma evacuated. The patient had normal results on neurological examination.

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    Left: Axial head CT obtained at 8–24 hours of metastatic brain tumor resection from the posterior fossa. The head CT reveals hemorrhage in the tumor bed. Right: Axial head CT obtained at 8–24 hours after total resection of an eosinophilic granuloma invading the dura mater. The head CT reveals hemorrhage into the operative area.

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    Left: Initial axial head CT obtained at 0–7 hours of SDH evacuation, revealing near complete resolution of the subdural fluid collection, with postoperative pneumocephalus. Right: Follow-up head CT obtained within 96 hours reveals rehemorrhage and reaccumulation of the SDH, with acute and subacute components.

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