The Limited Usefulness of Immediate Routine Postoperative MRI Scans Following Cranial Vault Reconstruction for Craniosynostosis Correction.

Cranial vault reconstruction (CVR) is a frequent treatment in patients with craniosynostosis. Complications are infrequent, including dural tears, CSF leaks, venous sinus injuries, and hemorrhages. Prior research demonstrated the limited utility of routine post-operative CT scans in uncomplicated craniosynostosis surgery, showing only one of 469 postop CTs after CVR resulted in a change in management. In this study, we investigate the utility of postop MRI after CVR. One hundred eleven consecutive routine MRIs for 107 patients on postoperative day 1 after open CVR spanning September 2018 to February 2023 were reviewed. Average age at surgery was 2 years 5 months. 25.2% of patients (n=28) had a prior craniosynostosis procedure. 71.1% of patients (n=79) had multi-suture synostosis, and 29.7% of patients (n=33) had syndromic synostosis, with Apert (12%, n=14) and Crouzon (10%, n=11) most prevalent. 71.1% of patients (n=79) underwent fronto-orbital advancement (FOA) and 23.4% of patients underwent posterior CVR (n=26). Only 2 postoperative MRIs changed management. One found an incidental cervical neoplastic lesion prompting follow-up with oncology. Another found asymptomatic and scattered foci of T2 prolongation, which resolved on a subsequent scan at 2 months postop and never produced clinical changes. Eighty-two percent of radiology impressions included post-operative extra-axial fluid collections, whereas 41% contained pneumocephalus, neither of which required intervention. Overall, 111 consecutive routine post-op day one MRIs yielded no changes in inpatient management related to post-surgical imaging findings. There are benefits of postop imaging (family and care team reassurance, education, new baseline), but routine postop MRI has limited utility for acute management.