The Utility of Early Postoperative Neuroimaging in Elective/Semielective Craniotomy Patients: A Single-Arm Prospective Trial
| Autor: | Ido Ben Zvi, Andrew A. Kanner, David Felzensztein, Netanel Ben Shalom, Noa Schwartz, Alon Orlev, Adam Loeub, Shlomo Gavrielli, Gustavo Rajz, Shani Berkowitz, Edna Inbar, Sagi Harnof, Ivan Novitsky, Saeed Yassin, Sher Matsri |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Device placement Neuroimaging Asymptomatic 03 medical and health sciences Young Adult 0302 clinical medicine medicine Humans Prospective Studies Prospective cohort study Craniotomy Aged Postoperative Care business.industry Brain Perioperative Middle Aged Surgery Prospective trial Elective Surgical Procedures 030220 oncology & carcinogenesis Female Neurology (clinical) Neurosurgery medicine.symptom business Tomography X-Ray Computed 030217 neurology & neurosurgery Algorithms |
| Zdroj: | World neurosurgery. 138 |
| ISSN: | 1878-8769 |
| Popis: | The necessity and timing of early postoperative imaging (POI) are debated in many studies. Despite the consensus that early POI does not change patient management, these examinations are routinely performed. This is the first prospective study related to POI. Our aims were to assess the necessity of early POI in asymptomatic patients and to verify accuracy of the presented algorithm.This was an algorithm-based prospective single-center study. The algorithm addressed preoperative, perioperative, and postoperative considerations, including estimated pathology type, device placement, and postoperative neurologic change. Early computed tomography scans were obtained in all patients, but if postoperative algorithm indications did not recommend a scan, the treating team was blinded to them, and patient management was conducted based on clinical examinations alone. A neuroradiologist and study-independent neurosurgeon reviewed all the scans.Of 103 enrolled patients, 88 remained asymptomatic, and 15 experienced symptoms postoperatively. Pathology was present on POI in 1% of the asymptomatic patients and 53% of the symptomatic patients (P0.001). In the asymptomatic group, no treatment modifications were made postoperatively. Blinding of the surgical team was not removed, and 20% of the symptomatic patients returned to the operating room because of imaging and neurologic findings. The goal of5% algorithm failure was reached with statistical significance.In asymptomatic postoperative patients in whom early imaging is not performed for oncologic indications, device placement verification, or similar reasons, POI is unnecessary and does not change the management of these patients. |
| Databáze: | OpenAIRE |
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