From the Department of Craniomaxillofacial Surgery, Erasmus University; the Department of Radiology, Department of Surgery, Division of Plastic Surgery, and Department of Neurological Surgery, University of Washington; and the Department of Pediatrics, Division of Craniofacial Medicine, Seattle Children's Hospital.
Plast Reconstr Surg. 2021 Jul 1;148(1):63e-70e. doi: 10.1097/PRS.0000000000008056.
Postoperative computed tomography scans allow for evaluation of the structural results of cranial vault reconstruction and potential surgical concerns. The authors evaluated the clinical utility of routine postoperative scans to identify relevant surgical findings in children treated for craniosynostosis.
The authors conducted a retrospective study of postoperative computed tomography reports for patients with craniosynostosis following cranial vault reconstruction during a 9-year period at their tertiary care pediatric hospital. They categorized postoperative computed tomography findings as typical, atypical, or indeterminate. Images with reported indeterminate or atypical findings were reviewed and verified by a pediatric neuroradiologist and a pediatric neurological surgeon. Clinical outcomes of patients with abnormal postoperative images were assessed with chart review for clinical relevance.
Postoperative computed tomography radiology reports for 548 operations in 506 participants were included. Most participants had single-suture craniosynostosis (89 percent), were male (64 percent), and under 1 year of age (78 percent). Surgically concerning scans were described in 52 reports (<9.5 percent), and the research team's pediatric neuroradiologist confirmed abnormal findings in 36 (6.5 percent). Potentially relevant abnormal findings included subdural blood (n = 18), subarachnoid blood (n = 4), intraparenchymal findings (n = 6), bone abnormalities (n = 5), vascular injury (n = 3), and increased ventricular size (n = 2). Most cases with abnormal findings did not require additional observation nor intervention. Only three cases (of 548; 0.55 percent) required further intervention, which included additional medical management (n = 2) and return to the operating room (n = 1).
Abnormal findings on routine computed tomography scans after cranial vault reconstruction are uncommon and rarely result in an urgent surgical or medical intervention.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.
术后计算机断层扫描可评估颅盖重建的结构结果和潜在的手术关注点。作者评估了常规术后扫描在评估接受颅缝早闭治疗的儿童中识别相关手术发现的临床实用性。
作者对 9 年间在他们的三级儿科医院接受颅盖重建的颅缝早闭患者的术后计算机断层扫描报告进行了回顾性研究。他们将术后计算机断层扫描结果分为典型、非典型或不确定。对报告有不确定或非典型发现的图像由儿科神经放射科医生和小儿神经外科医生进行回顾和验证。通过病历回顾评估具有异常术后图像的患者的临床结局，以评估其临床相关性。
纳入了 506 名患者 548 次手术的术后计算机断层扫描影像学报告。大多数患者为单一颅缝早闭（89%），男性（64%），年龄小于 1 岁（78%）。52 份报告描述了有手术关注的扫描（<9.5%），研究小组的儿科神经放射科医生确认了 36 份（6.5%）异常发现。潜在的相关异常发现包括硬膜下积血（n=18）、蛛网膜下腔积血（n=4）、脑实质内发现（n=6）、骨异常（n=5）、血管损伤（n=3）和脑室增大（n=2）。大多数有异常发现的病例不需要进一步观察或干预。仅有 3 例（548 例中的 0.55%）需要进一步干预，包括额外的药物治疗（n=2）和返回手术室（n=1）。
颅盖重建后常规计算机断层扫描的异常发现并不常见，很少导致紧急手术或药物干预。
临床问题/证据水平：诊断，IV。
