title: Immediate postoperative imaging after uncomplicated endoscopic approach to the anterior skull base: is it necessary?
abstract: BACKGROUND
  Postoperative imaging is frequently performed to assess for intracranial complications following anterior skull base (ASB) surgery. However, there is little data to suggest that radiologic studies change the management of complications. In this study, the utility of postoperative imaging within 72 hours after uncomplicated ASB surgery was examined.
  
  
  METHODS
  A retrospective review was conducted of 143 patients who underwent endoscopic ASB surgery between 2007 and 2013 at Loyola University Medical Center. The main outcomes measures included the ability of head computed tomography (CT) scan to identify postoperative complications and hallmark symptoms associated with complications.
  
  
  RESULTS
  Seventy-nine patients underwent postoperative imaging within 72 hours of the initial surgery. The most common finding was pneumocephalus (35/79; 44%). Expanding pneumocephalus requiring surgical intervention developed in 3 cases. Cerebrospinal fluid (CSF) leak was the most common complication, occurring in 22 of 143 (15%) of the patients. Of the 24 patients who developed a postoperative complication, all had clinical signs or symptoms indicative of the need for surgical or medical intervention. The positive predictive value for a head CT scan to detect a complication was 12%, negative predictive value was 92%, and sensitivity and specificity were 63% and 48%, respectively.
  
  
  CONCLUSIONS
  Routine postoperative imaging may be unnecessary after uncomplicated endoscopic ASB surgery because (1) it may not alter patient management; (2) it may not detect the most common complication (CSF leak); and (3) when imaging is positive, the patient has clinical symptoms suggesting a need for intervention.
authors.affiliation: Department of Otolaryngology, Loyola University Chicago Stritch School of Medicine, Maywood, IL.
authors.forename: Sahar
authors.initials: S
authors.lastname: Nadimi
authors.forename: Nadieska
authors.initials: N
authors.lastname: Caballero
authors.forename: Patrick
authors.initials: P
authors.lastname: Carpenter
authors.forename: Lauren
authors.initials: L
authors.lastname: Sowa
authors.forename: Ryan
authors.initials: R
authors.lastname: Cunningham
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Welch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis* / Q000209:etiology; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011007:Pneumocephalus / Q000175:diagnosis* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D019291:Skull Base / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CSF rhinorrhea; anterior skull base; computed tomography; endoscopic skull-base surgery; imaging; postoperative