The Utility of early postoperative neuroimaging in elective/semi-elective craniotomy patients: A single arm prospective trial

BACKGROUND: Necessity and timing of early post-operative imaging (POI) are the debate of many studies. Despite the consensus that early POI does not change patient management, these exams are routinely performed. This is the first prospective study related to POI. OBJECTIVE: To assess the necessity of early POI in the asymptomatic patient. The secondary goal was to verify accuracy of the presented algorithm. METHODS: An algorithm based prospective single center study. The algorithm has pre, peri and post-operative considerations, among them are estimated pathology type, device placement and post-operative neurological change. Early CT scans were performed to all patients, but if post-operative algorithm indications did not recommend a scan, the treating team was blinded to them, and patient management was conducted based on clinical exams alone. For safety, a neuroradiologist and study-independent neurosurgeon reviewed all the scans. RESULTS: Out of a 103 enrolled, 88 remained asymptomatic, 15 became symptomatic post-operatively. One percent of the asymptomatic and 53% of the symptomatic patients had pathologic POI (p<.001). In the asymptomatic group no treatment modifications were made post-operatively. Blinding of the surgical team was not removed. To the contrary, 20% of the symptomatic patients returned to the operating room because of imaging and neurologic findings. The goal of less than a 5% algorithm failure was reached with statistical significance. CONCLUSION: In the asymptomatic post-operative patient when early imaging isn't utilized for oncological, device placement verification or similar reasons, it is unnecessary and does not change the management of these patients.