Clinical Relevance of Early Cranial Computed Tomography-Imaging After Elective Brain Tumor Surgery in Children and Adolescents

BACKGROUND AND OBJECTIVES: This retrospective single-center cohort study evaluated the role of early postoperative computed tomography (EPOCT) after pediatric intracranial tumor resection, a practice that remains controversial. Although EPOCT is frequently used to detect early postoperative complications, evidence supporting its routine use in neurologically stable children is limited, and concerns regarding radiation exposure persist. The aim of this study was to assess the clinical relevance of routine EPOCT after elective intracranial tumor surgery in children and adolescents and to identify clinical and perioperative predictors of abnormal imaging findings and emergency return to the operating room (RTOR). METHODS: We included 240 pediatric patients (0-18 years) who underwent elective intracranial tumor resection and received EPOCT within 4 hours postoperatively. Clinical, surgical, and radiological variables were analyzed for associations with abnormal EPOCT findings and RTOR. Multivariable logistic regression and receiver operating characteristic analyses were performed to assess predictive value. RESULTS: No emergency RTOR was triggered by EPOCT findings alone in neurologically stable patients. Abnormal EPOCT findings were identified in 17/240 patients (7.1%). Emergency RTOR occurred in 12/240 cases (5.0%) unrelated to residual tumor; all were associated with postoperative neurological deterioration. Postoperative neurological deficits showed the strongest association with abnormal EPOCT (odds ratio 15.33). Additional significant predictors included surgical duration, preoperative external ventricular drain placement, ventricular size, and perioperative red blood cell transfusion. Neurological examination demonstrated higher sensitivity (100%) and negative predictive value (100%) for predicting emergency RTOR than EPOCT. CONCLUSION: EPOCT after pediatric intracranial tumor resection provides limited therapeutic benefit in clinically stable patients. Postoperative imaging should be applied selectively, guided primarily by neurological deterioration and supported by specific perioperative risk factors. A selective, clinically driven imaging strategy may reduce unnecessary radiation exposure without compromising patient safety.