Purpose
The neurosurgical cranial procedures are relatively frequent in the daily practice and a wide range of neurosurgical techniques has been developed to treat patients with intracraneal disorders.
Imaging is important in the routine postoperative follow-up of these patients.
The radiologist must know how to recognize postoperative complications and differentiate them from expected normal findings (Figure 1) because an early and accurate diagnosis is fundamental for proper postoperative care.
Interpretation of postoperative images requires knowledge of the normal cranial anatomy,
the surgical technique employed (burr holes,...
Methods and Materials
We retrospectively reviewed all the neurosurgical procedures performed at our center from January 2011 to April 2012,
following-up our patients until December 2012.
From an overall of 610 neurosurgical cranial procedures we included 411,
only those in wich the technique was burr holes,
craniectomy,
craniotomy or cranioplasty,
and excluding all the ventricular shunt placement procedures.
Postoperative control was carried out with CT,
MRI and cerebral angiography,
evaluating both expected imaging findings and complications.
With this 411 procedures we created a database in wich we included...
Results
From a total of 411 neurosurgical cranial procedures,
90/411 (22%) presented one or more postoperative complications (Table 1).
We found 18/90 (20%) extracranial herniations,
wich is a typical complication of the craniectomy (Figure 2).
The brain and vessels extrud through skull defect,
and if the defect is too small,
this can result in compression of cortical veins and lead to venous infarction and contusion of the brain at the craniectomy margins.
In our 46 patients who underwent decompressive craniectomy,
extracranial herniation occurred in 18 (39%)....
Conclusion
It is important for the radiologist to be familiar with the normal CT and MRI findings after each type of neurosurgical intervention,
as well as to recognize postoperative complications to prevent a delay in the diagnosis and treatment,
and thus a poor outcome.
A good correlation between the patient´s clinical status and imaging findings is also essential.
Postoperative complications in our hospital are more frequent among patients in patients who suffered a craneal trauma and those who underwent urgent neurosurgical cranial procedures.
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