Impact of Immediate Postlateral Skull Base Surgery CT Scans on Clinical Management

Abstract

Objectives:

Determine the frequency of abnormalities on immediate (<24 hours) postoperative CT scans for lateral skull base surgical patients and the impact of abnormalities found on postoperative management.

Methods:

Study Design: case series with chart review . Setting: inpatient tertiary care hospital. Adult patients undergoing lateral skull base surgery were identified using a CPT code search from September 2011 to December 2012. Patient demographics, type of skull base lesion, surgical approach, length of operation, time between end of the surgery and computed tomography (CT) scan, CT scan findings, and patient post-surgical neurologic status were collected.

Results:

Sixty-two patients were identified (mean age 48, 50% male). 32 patients had schwannomas, 11 cerebrospinal fluid leaks, 5 encephaloceles, 5 meningioma, 5 superior semicircular canal dehiscences, and 4 other disease processes. The approaches were middle fossa (28), translabyrinthine (20), suboccipital (3), retrosigmoid (3), and combined/other (8). Mean total anesthesia time was 6.5 hours (range 2.3 to 14 hours). Mean time between surgery and CT scan was 11 hours (range 3.5-17). Mild pneumocephalus was almost always found, along with mild extra-axial blood. Three patients had significant mass effect found on CT scan, but this was present preoperatively. One patient had a mild subdural without neurological decline. No patient suffered any drastic neurological decline, although one patient reported 4th and 5th finger numbness that resolved spontaneously.

Conclusions:

Clinically significant abnormalities on immediate postoperative CT scans were rare, as were cases of neurological decline. Further prospective studies would determine a reasonable algorithm for routine use of postoperative imaging.