Abstract
Craniotomy and craniectomy are widely performed emergent neurosurgical procedures and are the prescribed treatment for a variety of conditions from trauma to cancer. It is vital for the emergency radiologist to be aware of expected neuroimaging findings in post-craniotomy and craniectomy patients in order to avoid false positives. It is just as necessary to be familiar with postsurgical complications in these patients to avoid delay in lifesaving treatment. This article will review the commonly encountered normal and abnormal findings in post-craniotomy and craniectomy patients. The expected postoperative CT and MRI appearance of these procedures are discussed, followed by complications. These include hemorrhage, tension pneumocephalus, wound/soft tissue infection, bone flap infection and extradural abscesses. Complications specifically related to craniectomies include extracranial herniation, external brain tamponade, paradoxical herniation, and trephine syndrome.
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References
Donovan DJ et al (2006) Cranial burr holes and emergency craniotomy: review of indications and technique. J Neurosurg 122(5):1113–1119
Gooch MR, Gin GE, Kenning TJ, German JW (2009) Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 26(6):E9
Lonjaret L, Guyonnet M, Berard E, Vironneau M, Peres F, Sacrista S, Ferrier A, Ramonda V, Vuillaume C, Roux FE, Fourcade O, Geeraerts T (2017) Postoperative complications after craniotomy for brain tumor surgery. Anaesth Crit Care Pain Med 36(4):213–218
Sinclair AG, Scoffings DJ (2010) Imaging of the post-operative cranium. Radiographics 30(2):461–482
Elster AD, DiPersio DA (1990) Cranial postoperative site: assessment with contrast-enhanced MR imaging. Radiology 174(1):93–98
Sato N, Bronen RA, Sze G, Kawamura Y, Coughlin W, Putman CM, Spencer DD (1997) Postoperative changes in the brain: MR imaging findings in patients without neoplasms. Radiology 204(3):839–846
Meyding-Lamadé U et al (1993) Accelerated methemoglobin formation: potential pitfall in early postoperative MRI. Neuroradiology 35(3):178–180
Reasoner DK, Todd MM, Scamman FL, Warner DS (1994) The incidence of pneumocephalus after supra-tentorial craniotomy: observations on the disappearance of intracranial air. Anesthesiology 80(5):1008–1012
Carrau RL et al (1991) Computerized tomography and magnetic resonance imaging following cranial base surgery. Laryngoscope 101(9):951–959
Henegar MM, Moran CJ, Silbergeld DL (1996) Early postoperative magnetic resonance imaging following nonneoplastic cortical resection. J Neurosurg 84(2):174–179
Michel SJ (2004) The Mount Fuji sign. Radiology 232(2):449–450
Shi ZH, Xu M, Wang YZ, Luo XY, Chen GQ, Wang X, Wang T, Tang MZ, Zhou JX (2017) Post-craniotomy intracranial infection in patients with brain tumors: a retrospective analysis of 5723 consecutive patients. Br J Neurosurg 31(1):5–9
Delgado-López PD, Martín-Velasco V, Castilla-Díez JM, Galacho-Harriero AM, Rodríguez-Salazar A (2009) Preservation of bone flap after craniotomy infection. Neurocirugia (Astur) 20(2):124–131
Hlavin ML et al (1994) Intracranial suppuration: a modern decade of postoperative subdural empyema and epidural abscess. Neurosurgery 34(6):974–981
Farrell CJ, Hoh BL, Pisculli ML, Henson JW, Barker FG II, Curry WT Jr (2008) Limitations of diffusion-weighted imaging in the diagnosis of postoperative infections. Neurosurgery 62(3):577–583
Mollman HD, Haines SJ (1986) Risk factors for postoperative neurosurgical wound infection: a case-control study. J Neurosurg 64(6):902–906
Lanzieri CF, Som PM, Sacher M, Solodnik P, Moore F (1986) The postcraniectomy site: CT appearance. Radiology 159(1):165–170
Seifman MA, Lewis PM, Rosenfeld JV, Hwang PYK (2011) Postoperative intracranial haemorrhage: a review. Neurosurg Rev 34:393–407
Jeon JS et al (2006) Immediate postoperative epidural hematomas adjacent to the craniotomy site. J Korean Neurosurg Soc 39(5):335–339
Desai VR et al (2016) Incidence of intracranial hemorrhage after a cranial operation. Cureus 8(5):e616
Pandey P, Madhugiri VS, Sattur MG, Devi B I (2008) Remote supratentorial extradural hematoma following posterior fossa surgery. Childs Nerv Syst 24(7):851–854
Wolfsberger S, Gruber A, Czech T (2004) Multiple supra-tentorial epidural hematomas after posterior fossa surgery. Neurosurg Rev 27(2):128–132
Fukamachi A, Koizumi H, Nukui H (1985) Postoperative intracerebral hemorrhages: a survey of computed tomographic findings after 1074 intracranial operations. Surg Neurol 23(6):575–580
Heit JJ, Iv M, Wintermark M (2017) Imaging of intracranial hemorrhage. J Stroke 19(1):11–27
Stiver SI (2009) Complications of decompressive craniectomy for traumatic brain injury. Neurosurg Focus 26(6):E7
Chauhan NS, Banday IA, Morey P, Deshmukh A (2017) External brain tamponade: a rare complication of decompressive craniectomy. Intern Emerg Med 12:117–118
Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM (2006) Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 104:469–479
Akins PT, Guppy KH (2008) Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of decompressive craniectomy management. Neurocrit Care 9(2):269–276
Han PY, Kim JH, Kang HI, Kim JS (2008) Syndrome of the sinking skin-flap secondary to the ventriculoperitoneal shunt after craniectomy. J Korean Neurosurg Soc 43(1):51–53
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Chughtai, K.A., Nemer, O.P., Kessler, A.T. et al. Post-operative complications of craniotomy and craniectomy. Emerg Radiol 26, 99–107 (2019). https://doi.org/10.1007/s10140-018-1647-2
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DOI: https://doi.org/10.1007/s10140-018-1647-2