| I see quite a few patients in a neurovascular ICU | | | | neurosurgeon. The same study suggested that early |
| after a craniotomy for various reasons. It is very | | | | (within eight hours) study might fail to identify |
| important to identify even very subtle neurological | | | | post-operative complications all together. |
| changes which could be an early sign of a developing | | | | Even though, computed tomography provides |
| complication requiring another surgery. Often, I am | | | | physician with a high resolution image of the brain, it's |
| being asked by the patient's family when another CT | | | | expensive and associated with an exposure to |
| scan is going to be done to see if anything has | | | | radiation. Transferring a critically ill patient to the |
| changed. My answer is always that a good | | | | radiology department to perform a CT scan can lead |
| neurological exam is better that an imaging study to | | | | to complications as well. |
| detect early neurological changes. If the patient is | | | | This a single-center study with has its own limitations. |
| less responsive or developing new neurological | | | | It does not mean that there is no role for a follow-up |
| deficits, urgent CT scan would be indicated. | | | | computed tomography following craniotomy. It might |
| Recent single-center study published in the Journal of | | | | help to decide on the timing of anticoagulation |
| Neurosurgery addresses an issue of an optimal timing | | | | therapy for DVT prophylaxis or aid in determining the |
| for a follow-up CT scan after a cranial surgery. None | | | | patient's prognosis for recovery. |
| of the patients who had a follow-up scan without | | | | It's like ordering any other test - the physician should |
| any neurological changes require another craniotomy. | | | | have a very good understanding of why the test is |
| Thirty percent of the patients with new neurological | | | | being ordered and how that could change the |
| deficits needed a repeat neurosurgery. The optimal | | | | management. |
| timing of the follow-up scan is unclear as well. In my | | | | Good neuro-exam is better than CT scan to detect |
| practice it pretty much depends on an individual | | | | post-op complications. |