Article
Routine postoperative CT is not helpful after elective craniotomy
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Authors
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Christian Freyschlag
- Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Österreich
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Ricarda Gruber
- Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Österreich
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Marlies Bauer
- Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Österreich
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Claudius Thomé
- Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Österreich
| Published: | June 18, 2018 |
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Outline
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Objective: Next-day postoperative CT imaging is routinely used in neurosurgical departments to obtain radiographic "clearance" for transferring patients after elective craniotomy to the ward. Nonetheless, the value of routine CT imaging postoperatively is still uncertain. It has not been evaluated in a large cohort of elective tumor, epilepsy and vascular cases without emphasis on protocol changes to anesthesia or blood pressure management. In absence of randomized controlled trials, our study represents the first large cohort study of routine postoperative CT imaging in elective craniotomies.
Methods: All patients who underwent elective craniotomy for either tumor, epilepsy or vascular pathology were included in our study. Analysis was done in 3 steps. First, imaging of all patients was analyzed by a blinded rater. Second, all patients’ charts were reviewed retrospectively to obtain information about events of arterial hypertension and clinical deterioration, done by another blinded observer. Third, the data was put together and statistically analyzed.
Results: Mostly tumor resections (N=393, 59.5%), aneurysms (n=105, 15.9%) and skull base lesions were evaluated. Nearly half of the patients (n=264, 45.8%) showed presence of blood upon CT not suffering from any related symptomatology. A total of 21 patients (3.6%) showed a radiographic mass effect of postoperative hematoma, 11 of which were taken to revision surgery. The number of patients with episodes of arterial hypertension was found to be in a total of 8 patients (1.3%; >160mmHG = 5 >200mmHg = 3). There was a relation to revision surgeries (p=0.018). Of 660 craniotomies the rate of revision surgery was 18 patients (2.7%).
Conclusion: There is no need of routine postoperative CT in patients without postoperative deterioration of neurological status or consciousness after undergoing elective craniotomy.
