Clinical Significance and Utility of Early Postoperative Computed Tomography Scan Head after Brain Surgery: A Prospective Study.

Background and objective: Postoperative computed tomography (CT) scan has become a routine practice after any intracranial surgery. This study evaluates the clinical significance and utility of early postoperative CT scans after brain surgery in guiding patient management decisions.

Methods: A total of 339 patients who underwent intracranial surgery were included in the study. Postoperatively, patients were clinically examined in the intensive care unit and categorized into 3 groups: no fresh deficit, expected deficit, and unexpected deficit. All patients underwent a CT scan within 6 hours of surgery. CT findings were classified as postoperative changes only, operative site hematoma without mass effect, or operative site hematoma with mass effect. Management decisions were based on these findings, including continuation of ongoing management, modification of medical therapy, or surgical intervention if necessary.

Results: Among the 339 patients, 332 patients had either no deficit or expected deficit. 330 (97.34%) patients had postoperative changes only (eg, pneumocephalus, oedema, surgical corridor changes). Only 9 (2.65%) patients had operative site hematoma without mass effect. Of these 9, 6 patients required a change in medical management. However, no patient required surgical intervention even in unexpected deficit group. For the patients with unexpected deficit (n = 7, 2.06%), they were more likely to have an abnormal CT finding (odds ratio = 6.22, 95% CI 0.64-60.598, P = .193).

Conclusion: Early postoperative CT scans provide minimal benefit in extubated patients with no neurological deficit or expected deficits. Routine use of early CT scans does not significantly alter management and should be reserved for cases with clinical deterioration or unreliable neurological examination.