I see quite a few patients in a neurovascular ICU after a craniotomy for various reasons. It is very important to identify even very subtle neurological changes which could be an early sign of a developing complication requiring another surgery. Often, I am being asked by the patient’s family when another CT scan is going to be done to see if anything has changed.
My answer is always that a good neurological exam is better that an imaging study to detect early neurological changes. If the patient is less responsive or developing new neurological deficits, urgent CT scan would be indicated.

A recent single-center study published in the Journal of Neurosurgery addresses an issue
of an optimal timing for a follow-up CT scan after a cranial surgery. None of the patients who had a follow-up scan without any neurological changes require another craniotomy. Thirty percent of the patients with new neurological deficits needed a repeat neurosurgery.
The optimal timing of the follow-up scan is unclear as well. In my practice it pretty much depends on an individual neurosurgeon. The same study suggested that early (within eight hours) study might fail to identify post-operative complications all together.

Even though, computed tomography provides physician with a high resolution image of the brain, it’s expensive and associated with an exposure to radiation. Transferring a critically ill patient to the radiology department to perform a CT scan can lead to complications as well.

This a single-center study with has its own limitations. It does not mean that there is no role for a follow-up computed tomography following craniotomy. It might help to decide on the timing of anticoagulation therapy for DVT prophylaxis or aid in determining the patient’s prognosis for recovery.

It’s like ordering any other test – the physician should have a very good understanding of why the test is being ordered and how that could change the management.