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

Area of Science:

• Neurosurgery
• Radiology
• Evidence-based Medicine

Background:

• The utility of early postoperative computed tomography (EPOCT) after cranial surgery remains debated.
• A consensus on the routine use of EPOCT is lacking.

Purpose of the Study:

• To systematically review the usefulness of EPOCT combined with neurological examination versus neurological examination alone after elective craniotomies.
• To evaluate the impact of EPOCT on management decisions.

Main Methods:

• Systematic review of eight studies involving 3639 patients and 3737 imaging examinations.
• Inclusion criteria focused on EPOCT within 48 hours post-surgery and management changes based on findings.
• Analysis of asymptomatic versus neurologically deteriorating patient groups.

Main Results:

• Less than 0.8% of EPOCT scans in asymptomatic patients prompted intervention.
• 100% of patients with neurological deterioration underwent emergency surgery.
• The number needed to predict one management change was 8 for asymptomatic and 1.71 for symptomatic patients.

Conclusions:

• Current evidence does not support routine EPOCT in neurologically preserved patients after elective craniotomy.
• CT scanning should be reserved for specific clinical indications.
• An algorithm was developed to aid surgeons in decision-making, particularly in resource-limited settings.