Over the last few years, the role of early postoperative computed tomography (EPOCT) after cranial surgery has been repeatedly questioned, but there is yet no consensus on the practice. We conducted a systematic review to address the usefulness of EPOCT in association with neurological examination after elective craniotomies compared to the neurological examination alone. Studies were eligible if they provided information about the number of patients scanned, how many were asymptomatic or presented neurological deterioration before the scan and how many of each of those groups had their management changed due to imaging findings. CTs had to be performed in the first 48 h following surgery to be considered early. Eight studies were included. The retrospective studies enrolled a total of 3639 patients, with 3737 imaging examinations. Out of the 3696 CT scans performed in asymptomatic patients, less than 0.8% prompted an intervention, while 100% of patients with neurological deterioration were submitted to emergency surgery. Positive predictive values of altered scans were 0.584 for symptomatic patients and 0.125 for the asymptomatic. The number of altered scans necessary to predict (NNP) one change in management for the asymptomatic patients was 8, while for the clinically evident cases, it was 1.71. The number of scans needed to diagnose one clinically silent alteration is 134.75, and postoperative imaging of neurologically intact patients is 132 times less likely to issue an emergency intervention than an altered neurological examination alone. EPOCT following elective craniotomy in neurologically preserved patients is not supported by current evidence, and CT scanning should be performed only in particular conditions. The authors have developed an algorithm to help the judgment of each patient by the surgeon in a resource-limited context.

过去几年，颅骨手术后早期术后计算机断层扫描（EPOCT）的作用一再受到质疑，但在实践上尚未达成共识。我们进行了一项系统评价，以探讨与单独的神经系统检查相比，EPOCT 与选择性开颅手术后神经系统检查相关的有效性。如果研究提供了有关扫描患者数量、扫描前无症状或出现神经功能恶化的信息，以及每组中有多少人因影像学结果而改变管理等信息，则符合条件。为了尽早考虑，必须在手术后的前 48 小时内进行 CT。包括八项研究。回顾性研究共招募了 3639 名患者，进行了 3737 次影像学检查。在对无症状患者进行的 3696 次 CT 扫描中，只有不到 0.8% 的患者需要进行干预，而 100% 的神经功能恶化患者接受了急诊手术。改变扫描的阳性预测值对于有症状患者为 0.584，对于无症状患者为 0.125。预测 (NNP) 无症状患者的一次管理变化所需的扫描更改次数为 8，而对于临床明显病例，则为 1.71。诊断一种临床无症状改变所需的扫描次数为 134.75，并且神经功能完好患者的术后成像发出紧急干预的可能性是单独改变神经系统检查的 132 倍。当前证据不支持神经功能保留患者择期开颅手术后的 EPOCT，CT扫描只能在特定条件下进行。作者开发了一种算法，可帮助外科医生在资源有限的情况下对每位患者进行判断。