title: Clinical impact of early CT scans after lateral skull-base surgery.
abstract: OBJECTIVE
  To determine the frequency and clinical significance of abnormalities on postoperative computerized tomography (CT) scans performed within 24 hours after lateral skull base surgery.
  
  
  METHODS
  Case series with chart review. Setting Inpatient tertiary care hospital.
  
  
  METHODS
  Adult patients undergoing lateral skull base surgery were identified using CPT code search from January 2010 to January 2013. Patient demographics, type of skull base lesion, surgical approach, length of operation, time between end of the surgery and CT scan, CT scan findings, and patients' postsurgical neurologic status were collected.
  
  
  RESULTS
  One hundred and seventy-two patients were identified who had a postoperative CT scan after lateral skull base surgery. Diagnoses included schwannoma (95), cerebrospinal fluid fistula (29), middle fossa encephaloceles (9), meningioma (13), superior semicircular canal dehiscence (12), and other disease processes (14). The approaches were middle fossa (64), translabyrinthine (70), suboccipital (17), infratemporal (8), and combined/other (13). Mild pneumocephalus was almost always found, along with mild extra-axial blood. Twenty-four patients had significant mass effect found on CT scan, but this was present preoperatively. Three patients had a mild subdural without neurological decline. No patient suffered any clinically significant neurological decline, although 5 patients reported finger numbness that resolved spontaneously and 2 patients had confusion in the immediate postoperative period.
  
  
  CONCLUSIONS
  Clinically significant abnormalities on immediate postoperative CT scans were rare, as were cases of neurological decline. Further prospective studies could determine a more cost-effective algorithm for routine use of postoperative imaging.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas at Southwestern, Dallas, Texas, USA.
authors.forename: Zi Yang
authors.initials: ZY
authors.lastname: Jiang
authors.forename: Kyle
authors.initials: K
authors.lastname: Allen
authors.forename: J Walter
authors.initials: JW
authors.lastname: Kutz
authors.forename: Brandon
authors.initials: B
authors.lastname: Isaacson
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011184:Postoperative Period; D011446:Prospective Studies; D015203:Reproducibility of Results; D019291:Skull Base / Q000000981:diagnostic imaging* / Q000601:surgery; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT scan; lateral skull base surgery; postoperative care