Endoscopic ventral skull base surgery: Is early postoperative imaging warranted for detecting complications?

• Published in: The Laryngoscope 2015-05, Vol.125 (5), p.1072-1076
• Main Authors: Diaz, Lucia, Mady, Leila J., Mendelson, Zachary S., Liu, James K., Eloy, Jean Anderson
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; complications; CSF leak; Diagnostic Imaging - methods; Early Diagnosis; endoscopic skull base surgery; Endoscopy; Endoscopy - adverse effects; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Medical imaging; Medical research; Middle Aged; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; NMR; Nuclear magnetic resonance; pneumocephalus; Postoperative Complications - diagnosis; postoperative imaging; Reproducibility of Results; Retrospective Studies; Skull base; Skull Base - surgery; Skull Base Neoplasms - surgery; skull base surgery complications; subdural hematoma; Surgery; Time Factors; Tomography, X-Ray Computed; ventral skull base surgery; Young Adult
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.25086

Objectives/Hypothesis Following endoscopic ventral skull base surgery (EVSBS), it is common practice to obtain early postoperative imaging. The role of postoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans in these patients remains unclear. This study aims to determine the clinical utility of early postoperative imaging after EVSBS for detecting postoperative complications. Methods A retrospective chart analysis of 224 cases of purely EVSBS between 2009 and 2014 was performed. Data were collected regarding postoperative CT and MRI as well as hospital course. Interpretations of postoperative imaging were separated into two groups: 1) using radiologist's interpretation alone and 2) using surgeon knowledge of the case in tandem with imaging. Results Postoperative imaging was obtained in 213 cases (204 CT, 170 MRI) within 48 hours of surgery. Interpretation by a radiologist yielded a significantly higher rate of false positives (FP) on CT (15/204) and MRI (8/170) when compared to surgeon interpretation (CT FP =1/204 and MRI FP = 1/170) (P = 0.0004 and P = 0.0366, respectively), as well as a significantly lower rate of true negatives (TN) on CT (172/204 vs. 186/204) (P = 0.0497), whereas MRI data had a similar rate of TN (150/170 vs. 157/170; P = 0.2717). The rate of postoperative complications was 7.14% (16/224). In all cases of postoperative complications that required intervention, patients exhibited clinical symptoms. Conclusion Based on our findings, the benefit of early postoperative imaging to detect complications may be limited. When positive imaging findings were encountered, their value were somewhat negated by preceding clinical symptoms. Level of Evidence 4. Laryngoscope, 125:1072–1076, 2015