The Limited Usefulness of Immediate Routine Postoperative MRI Scans Following Cranial Vault Reconstruction for...

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Neuroradiology

Background:

• Craniosynostosis requires cranial vault reconstruction (CVR), a common pediatric surgical procedure.
• Complications from CVR are infrequent but can include dural tears, CSF leaks, and hemorrhages.
• Previous studies indicated limited value of routine postoperative CT scans following CVR.

Purpose of the Study:

• To investigate the clinical utility and impact of routine postoperative day 1 MRI scans after open cranial vault reconstruction.
• To determine if routine postoperative MRI findings alter inpatient management or lead to changes in patient care after CVR.

Main Methods:

• A retrospective review of 111 consecutive postoperative day 1 MRI scans from 107 patients who underwent open CVR between September 2018 and February 2023.
• Analysis included patient demographics, surgical procedures (e.g., fronto-orbital advancement, posterior CVR), synostosis type (syndromic, multi-suture), and prior surgical history.
• Radiology impressions and clinical management changes related to MRI findings were assessed.

Main Results:

• Only 2 out of 111 routine postoperative MRIs led to a change in management: one identified an incidental cervical neoplasm, and another showed transient T2 prolongation.
• Common findings like extra-axial fluid collections (82%) and pneumocephalus (41%) were frequently noted but typically asymptomatic and required no intervention.
• No changes in inpatient management were directly attributed to the imaging findings on routine postoperative day 1 MRIs.

Conclusions:

• Routine postoperative day 1 MRI scans after cranial vault reconstruction have limited utility for acute inpatient management decisions.
• While offering reassurance and establishing a baseline, the routine use of these MRIs does not significantly impact immediate clinical care following CVR.
• Further evaluation is needed to define the precise role and optimal timing of postoperative imaging in CVR patients.