Tag: Patient management

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Clinical Significance and Utility of Early Postoperative Computed Tomography Scan Head after Brain Surgery

Neurosurgery 98:810–817, 2026

This prospective single-center study assesses the clinical value of routine early (within 6 hours) postoperative CT scans in 339 adults after intracranial surgery, correlating immediate neurological status with CT findings and resulting management changes. Results show 97.3% had only expected postoperative changes, 2.7% had hematoma without mass effect, and none required surgical intervention; only six patients had medical management altered.

The authors conclude that routine early CT provides minimal benefit for extubated, neurologically stable or expected-deficit patients and advocate selective imaging for clinical deterioration or unreliable examinations, highlighting cost, radiation, and logistical considerations particularly relevant to resource-limited settings.

Aim Evaluate whether an early postoperative head CT within 6 hours after intracranial surgery changes patient management and assess its clinical utility.

Design/setting Single-center prospective cohort of 339 intracranial surgery patients; all received CT within 6 hours and were grouped clinically as no deficit, expected deficit, or unexpected deficit.

CT classification Imaging findings were categorized as postoperative changes only, operative site hematoma without mass effect, or hematoma with mass effect (with management options: no change, medical change, or surgery).

Key findings (imaging) 97.3% (330/339) showed postoperative changes only; 2.7% (9/339) had operative site hematoma without mass effect; 0% had hematoma with mass effect.

Key findings (management impact) 98.2% (333/339) had no change in management based on early CT; 1.8% (6/339) had a change in medical management; 0% required surgical intervention.

Neurological status distribution Postoperatively, 90.9% had no fresh deficit, 7.1% had an expected deficit, and 2.1% had an unexpected deficit.

Association signal Patients with unexpected neurological deficits were more likely to have abnormal CT findings (reported OR 6.22, wide CI, P = .193, not statistically significant).

Bottom line Early postoperative CT offers minimal benefit for extubated patients with no or expected deficits; CT should be reserved for clinical deterioration or unreliable neurological examination.

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Are stereotactic sample biopsies still of value in the modern management of pineal region tumours? Lessons from a single-department, retrospective series

Acta Neurochir (2011) 153:1111–1122. DOI 10.1007/s00701-010-0936-7

Recent improvements in imaging-based diagnosis, the broader application of neuroendoscopic techniques and advances in open surgery techniques mean that the need for stereotactic biopsies in the management of pineal region tumours must be reevaluated. The primary aim of this retrospective study was to establish whether stereotactic biopsy is still of value in the modern management of pineal region tumours.

Methods From 1985 to 2009, 88 consecutive patients underwent a stereotactic biopsy in our institution (51 males and 37 females; median age at presentation 30; range 2–74).

Results Accurate tissue diagnoses were obtained in all but one case (i.e. 99%). In one case (1%), three distinct stereotactic procedures were necessary to obtain a tissue diagnosis. There was no mortality or permanent morbidity associated with stereotactic biopsy. One patient (1%) presented an intra-parenchymal hematoma but no related clinical symptoms. Five patients (6%) presented transient morbidity, which lasted for between 2 days and 3 weeks after the biopsy.

Conclusions To guide subsequent treatment, we believe that histological diagnosis is paramount. Stereotactic biopsies are currently the safest and the most efficient way of obtaining this essential information. Recent improvements in stereotactic technology (particularly robotic techniques) appear to be very valuable, with almost no permanent morbidity or mortality risk and no decrease in the accuracy rate. In our opinion, other available neurosurgical techniques (such as endoscopic neurosurgery, stereotactic neurosurgery and open microsurgery) are complementary and not competitive.

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