Routine postoperative computed tomography scan after craniotomy: systematic review and evidence-based recommendations

Blumrich, Lukas; Telles, João Paulo Mota; Silva, Saul Almeida da; Iglesio, Ricardo; Teixeira, Manoel Jacobsen; Figueiredo, Eberval Gadelha

doi:10.1007/s10143-021-01473-w

Cited by 7 publications

(5 citation statements)

References 52 publications

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“…Asymptomatic patients appeared in the series presented by Wen et al, where, out of 1.9 % (15/786) requiring recraniotomy due to hematoma, 0.7% (5/721) were without clinical manifestations [ 31 ]. Similar results were presented in a systematic review by Blumrich et al In their paper, 0.756% of asymptomatic patients after POCT required intervention, with 21.4% on that basis qualifying for emergency operation [ 7 ]. In the work of Fontes and colleagues, approximately 90% of patients with no deterioration and expected deterioration had predictable POCTs.…”

Section: Discussionsupporting

confidence: 81%

“…After neurosurgical procedures, an early POCT is performed to detect complications such as hemorrhage, ischemia, oedema, or hydrocephalus [ 7 ]. Strict concomitant clinical observation with neurological examination is a standard in postsurgical care [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Attempts were made to construct screening guidelines or algorithms for postcraniotomy radiological evaluation. None has come to a standard of care and wide clinical practice, leading to discrepancies in management between hospitals [ 7 , 10 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Relevance of Routine Postoperative CT Scans Following Aneurysm Clipping—A Retrospective Multicenter Analysis of 423 Cases

Krakowiak

Fercho

Szmuda

et al. 2022

JCM

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Aim: Postoperative head computed tomography (POCT) is routinely performed in numerous medical institutions, mainly to identify possible postsurgical complications. This study sought to assess the clinical appropriateness of POCT in asymptomatic and symptomatic patients after ruptured or unruptured aneurysm clipping. Methods: This is a retrospective multicenter study involving microsurgical procedures of ruptured (RA) and unruptured intracranial aneurysm (UA) surgeries performed in the Centers associated with the Pomeranian Department of the Polish Society of Neurosurgeons. A database of surgical procedures of intracranial aneurysms from 2017 to 2020 was created. Only patients after a CT scan within 24 h were included. Results: A total of 423 cases met the inclusion criteria for the analysis. Age was the only significant factor associated with postoperative blood occurrence on POCT. A total of 37 (8.75%) cases of deterioration within 24 h with urgent POCT were noted, 3 (8.1%) required recraniotomy. The highest number necessary to predict (NNP) one recraniotomy based on patient deterioration was 50 in the RA group. Conclusion: We do not recommend POCTs in asymptomatic patients after planned clipping. New symptom onset requires radiological evaluation. Simultaneous practice of POCT after ruptured aneurysm treatment within 24 h is recommended.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Relevance of Routine Postoperative CT Scans Following Aneurysm Clipping—A Retrospective Multicenter Analysis of 423 Cases

Krakowiak

Fercho

Szmuda

et al. 2022

JCM

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“…18,19 In addition, many studies have shown no need for early postoperative CT scans for elective neurosurgery. [20][21][22] Nevertheless, new ndings in postoperative CT scans in patients submitted to brain trauma surgery are common (15.6%-40%), especially in patients sustaining ASDH or submitted to decompressive craniectomy. [23][24][25] Therefore, we believe that a postoperative CT scan after a brain trauma patient should be performed on every patient, even if they have intracranial pressure (ICP) monitoring implanted.…”

Section: Discussionmentioning

confidence: 99%

Sequential changes in Rotterdam Scoring System in patients submitted to acute subdural hematoma evacuation

Oliveira

Gonçalves

Cabral

et al. 2023

Preprint

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Background: Rotterdam Scoring System (RSS) is a head computed tomography (CT) -based system for evaluating Traumatic brain injury (TBI). This system provides a better estimation of disease prognosis. Our objective was to study the sequential changes in RSS following the evacuation of acute subdural hematoma (ASDH) and evaluate if these changes were associated with 14-day mortality and in-hospital mortality. Methods: This is a retrospective study from a prospective database registry of TBI patients. Results: Pre-and Post-op RSS represented a higher association with 14-day mortality (p=0.01 and p=0.004, respectively)) and in-hospital mortality (p=0.01 and p=0.001, respectively). Pupils and post-op RSS were the independent predictors for in-hospital mortality (OR=1.99, 95%CI 1.14-3.48, p=0.015). Conclusion: The postoperative RSS is a promising tool for evaluating prognosis in patients submitted to the evacuation of ASDH.

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“…In addition, intraoperative imaging should be performed to check the position of the electrode, which is also used in some cases during the placement of cochlear implants [35]. Furthermore, postoperative imaging could be performed to rule out intracranial complications such as hemorrhage in some patients with a higher risk of intracranial complications [36]. To monitor the risk of persisting CSF leakage after reconstruction of the skull base, a preoperative intradural dye injection could be considered.…”

Section: Discussionmentioning

confidence: 99%

Surgical Approaches for Possible Positions of an Olfactory Implant to Stimulate the Olfactory Bulb

Menzel

Konstantinidis

Valentini

et al. 2023

ORL

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Introduction: Current scientific developments seem to allow for an “olfactory implant” in analogy to cochlear implants. However, the position and surgical approaches for electrical stimulation of the olfactory system are unclear. Methods: In a human anatomic cadaver study, we investigated different endoscopic approaches to electrically stimulate the olfactory bulb (OB) based on the following considerations: (1) the stimulating electrode should be close to the OB. (2) The surgical procedure should be as non-invasive and safe as possible and (3) as easy as possible for an experienced ENT surgeon. Results: In summary, the endoscopic intracranial positioning of the electrode via a widened ostium of the fila olfactoria or a frontal sinus surgery like a Draf IIb procedure is a good option in terms of patients’ risk, degree of difficulty for ENT surgeons, and position to the OB. Endoscopic intranasal positioning appeared to be the best option in terms of patient risk and the degree of difficulty for ENT surgeons. Although a bigger approach to the OB using a drill and the combined intranasal endoscopic and external approach enabled a close placement of the electrode to the OB, they do not seem relevant in practice due to their higher invasiveness. Conclusion: The study suggested that an intranasal positioning of a stimulating electrode is possible, with placements beneath the cribriform plate, extra- or intracranially, applying elegant surgical techniques with low or medium risk to the patient and a close placement to OB.

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Routine postoperative computed tomography scan after craniotomy: systematic review and evidence-based recommendations

Cited by 7 publications

References 52 publications

Relevance of Routine Postoperative CT Scans Following Aneurysm Clipping—A Retrospective Multicenter Analysis of 423 Cases

Relevance of Routine Postoperative CT Scans Following Aneurysm Clipping—A Retrospective Multicenter Analysis of 423 Cases

Sequential changes in Rotterdam Scoring System in patients submitted to acute subdural hematoma evacuation

Surgical Approaches for Possible Positions of an Olfactory Implant to Stimulate the Olfactory Bulb

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