Evaluation of the necessity of postoperative imaging after craniosynostosis surgery

Childhood radiation exposure increases the lifetime risk of cancer from an estimated 0.07 to 0.35%. Neurological evaluation of patients after cranial vault reconstruction for synostosis repair is often complicated by pain medication, sedation, intubation, swelling, and dressings; therefore computed tomography (CT) scans are routinely ordered by some surgeons on the 1st postoperative day. The object of this study was to evaluate the utility of these scans.

Medical records and CT scans were reviewed for patients at the authors' institution who underwent cranial vault reconstruction to repair synostosis between January 1, 2003, and July 31, 2005.

Of the 111 patients identified in the review, 84 had a CT scan on postoperative Day 1, and seven of these patients underwent shunt insertion for treatment of hydrocephalus. Thirty-three patients underwent bifrontal craniotomies, whereas 51 underwent total vault reconstruction (TVR). Postoperative CT scans revealed minor contusions in three (9%) of 33 patients in the bifrontal craniotomy group and in seven (14%) of 51 patients in the TVR group. No significant subdural or epidural hematomas were observed. In the seven patients who required shunt placement, two (29%) had CT evidence of shunt malfunction, leading to shunt revision.

None of the CT findings analyzed in this series was associated with clinical events such as seizures, prolonged intensive care unit stay, or reoperation in patients without shunt placement after cranial reconstructive procedures, although a relatively high incidence of CT evidence of shunt malfunction was found in patients with shunts. These data do not support the routine use of CT scanning after cranial reconstructive procedures unless the patient has received a shunt for hydrocephalus. Patients who experience unexpected intraoperative or postoperative events should be examined using CT.