S4A-04 SESSION 4A: GENERALITIES IN CRANIOSYNOSTOSIS – PART I EVALUATING THE UTILITY OF POSTOPERATIVE COMPUTED TOMOGRAPHY SCANS FOLLOWING CRANIAL VAULT RECONSTRUCTION SURGERY FOR CRANIOSYNOSTOSIS

Abstract

Introduction: To evaluate the utility of routine immediate post-operative computed tomography (CT) scans after cranial vault reconstruction surgery for craniosynostosis. Methods: We reviewed intraoperative events and post-operative CT scans for patients with craniosynostosis who underwent cranioplasty between October 2009 and June 2018 at our institution after implementing a standard treatment protocol. We categorized common CT findings and identified the reporting radiologists’ assessment of whether the post-operative CT findings were expected, indeterminate, or unexpected results, including communicated critical results Results: Over a 10-years period, 507 participants were found eligible for enrollment. 39 of these patients had two or more surgeries, resulting in a total number of 550 surgeries. 64.5% of these patients were male, most surgeries (40.2%) were performed between 7–12 months of age and ~90% of these patients had single suture craniosynostosis. Most (82.7%) CT scans (455/550) showed expected post-operative findings and include intracranial, extradural air and fluid as common findings. Unexpected findings were described by the radiologist in 8% (n=44/550) of CT scans. A pediatric neuroradiologist confirmed abnormal findings in 52.3% (n=23), and these included: subdural hemorrhages (21.7%, n=5), subarachnoid hemorrhages (17.4%, n=4), intraparenchymal hemorrhages (13%, n=3), dural venous injury (13%, n=3) and displaced bone fragments (13%, n=3). Two cases had CT reports that described findings concerning for cerebral infarct; however, no infarct was identified on follow-up imaging. Increasing ventriculomegaly was identified in 8.7% of these cases (2/23). Bone flap was reported in 1 case (4.3%). In 52.2% (12/23) of these cases a close observation leading to additional images was required. In one case (4.3%) an intervention with anti-thrombolytic agents was required. Return to the operation room (OR) was required for one case (4.3%). For the remainder 9 cases (39.1%) no clinical action was performed. Conclusion: Abnormal findings on post-operative CT scans following cranial vault reconstruction surgery are relatively uncommon, and unexpected findings were identified in 4.2% (23/550). Whereby only 2 of these cases led to a significant intervention, return to the OR and an anti-thrombolytic management. For the remaining 21 cases no intervention was required except for close observation leading in 12 cases to additional CT imaging.