Postoperative Care of Patients with High-grade Glioma: Is There a Real Need for the Neurocritical ICU and Early CT Scan?
BACKGROUND
Pressure on economic resources now requires a careful rationalization of services. For adult patients with supratentorial gliomas, there is no consensus on the real need for care in a postoperative neurocritical intensive care unit (NICU) and on the timing of a postsurgical computed tomography (CT) scan. In this retrospective nonrandomized study, we assessed if and when there is a real need for NICU and if an early CT scan could be justified in the absence of neurologic worsening.


METHODS
Of 264 patients, 21 were admitted to the NICU after the procedure as planned before the surgery for their clinical features (Karnofsky performance status < 70, American Society of Anesthesiologists score > 2, or Charlson Comorbidity Index > 5).


RESULTS
The mean stay in the NICU was 19.7 hours. One of these patients had developed a postoperative hematoma that was subsequently removed, and died afterward. The other 243 patients were followed clinically after the procedure: 219 underwent a cerebral CT scan 24 hours after the procedure and were discharged in good condition. The other 24 patients had a cerebral CT scan within 24 hours after the procedure. The early CT showed the presence of a local edema in five cases and a hematoma surgically treated with a subsequent admission to the NICU in two cases.


CONCLUSIONS
Considering our data, we suggest that NICU should not always be used after craniotomy for supratentorial gliomas. Clinical observation was sufficient to predict early postoperative complications. A CT scan before 24 hours after surgery is not recommended in the absence of clinical worsening.
Department of Neurosurgery, University of Turin, Turin, Italy.
Roberto
R
Altieri
Department of Neurosurgery, University of Turin, Turin, Italy.
Fabio
F
Cofano
Department of Neurosurgery, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
Alessandro
A
Agnoletti
Department of Neurosurgery, Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, Piemonte, Italy.
Riccardo
R
Fornaro
Department of Neurosurgery, University of Turin, Turin, Italy.
Marco
M
Ajello
Department of Neurosurgery, University of Turin, Turin, Italy.
Francesco
F
Zenga
Department of Neurosurgery, University of Turin, Turin, Italy.
Alessandro
A
Ducati
Department of Neurosurgery, University of Turin, Turin, Italy.
Diego
D
Garbossa
D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011184:Postoperative Period; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed