• Ido Ben Zvi, Sher Matsri, David Felzensztein, Saeed Yassin, Alon Orlev, Netanel Ben Shalom, Shlomo Gavrielli, Edna Inbar, Adam Loeub, Noa Schwartz, Gustavo Rajz, Ivan Novitsky, Andrew Kanner, Shani Berkowitz, and Sagi Harnof.
• Neurosurgery Department, Rabin Medical Center, Petah Tikva, Israel. Electronic address: idobenz@gmail.com.
• World Neurosurg. 2020 Jun 1; 138: e381-e388.

BackgroundThe necessity and timing of early postoperative imaging (POI) are debated in many studies. Despite the consensus that early POI does not change patient management, these examinations are routinely performed. This is the first prospective study related to POI. Our aims were to assess the necessity of early POI in asymptomatic patients and to verify accuracy of the presented algorithm.MethodsThis was an algorithm-based prospective single-center study. The algorithm addressed preoperative, perioperative, and postoperative considerations, including estimated pathology type, device placement, and postoperative neurologic change. Early computed tomography scans were obtained in all patients, but if postoperative algorithm indications did not recommend a scan, the treating team was blinded to them, and patient management was conducted based on clinical examinations alone. A neuroradiologist and study-independent neurosurgeon reviewed all the scans.ResultsOf 103 enrolled patients, 88 remained asymptomatic, and 15 experienced symptoms postoperatively. Pathology was present on POI in 1% of the asymptomatic patients and 53% of the symptomatic patients (P < 0.001). In the asymptomatic group, no treatment modifications were made postoperatively. Blinding of the surgical team was not removed, and 20% of the symptomatic patients returned to the operating room because of imaging and neurologic findings. The goal of <5% algorithm failure was reached with statistical significance.ConclusionsIn asymptomatic postoperative patients in whom early imaging is not performed for oncologic indications, device placement verification, or similar reasons, POI is unnecessary and does not change the management of these patients.Copyright © 2020 Elsevier Inc. All rights reserved.

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