The data was prospectively collected and anonymously entered in an electronic database. The histology reports of all intracranial tumors were reviewed. Patients were followed for 30 days after the index surgery. ![]() Patient data as defined in a case report form included patient demographics, American Society of Anesthesiologists (ASA) classification of Physical Status Score, preoperative medication and hematological laboratory results, entity and location of primary cranial lesion, mode of anesthesia, time from skin closure to extubation, need for emergency head CT within 48 hours postoperatively, and indication for urgent return to the OR or ventriculostomy outside of the OR. The hypothesis was that the early extubation with dedicated neurological monitoring and no routine head CT strategy provides sufficient patient safety as compared with reported data in the literature. ![]() ![]() Therefore we prospectively analyzed a strategy of early extubation without routine head CT after elective cranial neurosurgical procedures. No evidence from prospective studies exist to support these assumptions. postoperative hemorrhage, brain swelling). The concerns for latter strategy may originate from a fear of too much cardiopulmonary and metabolic distress to the just trephined patient caused by an immediate (“forced”) awakening and extubation with potential sequelae (e.g. Still, some institutions-at least within Europe-prefer a delayed extubation with parameter focused monitoring on the intensive care unit (ICU) over an early extubation in the OR with clinical-neurological monitoring of the awakened patient. Today most neurosurgical patients are awakened directly postoperatively in the OR for clinical assessment. Early termination of anesthesia and early extubation is, of course, mandatory for a thorough neurological examination. Results of recent studies and clinical reasoning argue that repetitive neurological examination and surveillance is key for detection of complications with the need for return to the operating room (OR). However, there is growing evidence from retrospective series that routine head CT may not be necessary after neurosurgical cranial procedures. This practice of routine head CT scanning has not been substantiated by any prospective evidence, but is perpetuated by common procedural standards and training background of the neurosurgeons. In many departments patients are not transferred to the wards until they have been “cleared” by CT scanning. These imaging studies are often ordered even in the absence of unexpected neurological findings in order to rule out complications. ![]() Since the introduction of computed tomography (CT) in the 1970s, postoperative head CT within the first hours after neurosurgery has been advocated. The common objective in this crucial period is to avoid or detect any early postoperative complications such as intracranial bleeding, ischemia, or brain swelling. Postoperative patient management following elective cranial surgery varies substantially between different neurosurgical institutions.
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