Pre-operative imaging and post-operative appearance of standard paediatric neurosurgical approaches: a training guide for neuroradiologists

Abstract

A short-cut narrative review was conducted according to the SANRA guidelines to identify studies describing normal and abnormal postoperative radiological features of the most common paediatric neurosurgical procedures. Rather than focusing on the original pathology addressed by neurosurgical means, this review explored three main areas of operative neurosurgery: ventricular access, supratentorial & infratentorial craniotomies, and posterior fossa/craniocervical junction decompression. A total of twenty-three landmark papers were included for review based on their relevance to address the research question and serve as a practical guide for paediatric neuroradiology trainees and fellows. Accurate in text referencing of the ClinicalTrials.gov identifier, and weblink, has also been provided for all trials discussed in the results section. All the above is complemented by relevant iconography meant to describe a wide range of postoperative changes and early complications. Finally, the review is enriched by a discussion touching upon haemostatic agents, intentionally retained foreign bodies and the future of machine learning for neuroradiology reporting. Overall, the information presented in a systematic fashion will not only help trainees and fellows to deepen these topics and expand their knowledge in preparation for written and oral boards, but will also represent a useful resource for everyone including trained neuroradiologists and neurosurgeons themselves.

Keywords: Neuroimaging; artificial intelligence; medico-legal; neuroradiology reporting; postoperative complications.

Figure 1

Craniometrics coordinates for Kocher’s point (Left image) and overview of burr hole on postoperative 3D CT scan (Right image).

Figure 2

Revision of ventriculoperitoneal shunt using Keen’s point (Left image, axial CT scan, please note the white arrows indicating the previous trajectory) compared to craniometrics coordinates for ventricular access through Frazier’s point (Right image, please note the black arrow indicating the direction aimed during ventricular cannulation).

Figure 3

Sagittal FIESTA MRI scan of 3 years old patient undergoing endoscopic third ventriculostomy (ETV) for acqueductal stenosis (Left image, preoperative scan showing the radiological signs of raised intracranial pressure) with resolution of clinical signs of raised intracranial pressure (Right image, postoperative scan showing flow void and turbulent cerebrospinal fluid flow through the artificial communication created in the floor of third ventricle, with a concomitant relaxed appearance of the third ventricle).

Figure 4

Craniotomies for surgical approaches to Anterior, Middle and Posterior Fossae

Figure 5

Preoperative and postoperative neuroradiology workup in 5 years old patient undergoing Left fronto-temporal craniotomy for craniopharyngioma following previous contralateral approach (Left image, preoperative sagittal contrast-enhanced T1WI MRI showing the suprasellar extension of the lesion; Right image, axial CT scan demonstrating intraventricular cannula in the antrum of Right lateral ventricle for shunting purposes, Right frontal parenchymal trajectory of intralesional cannula for Ommaya reservoir, Left frontal ischaemic changes following surgical retraction to access and debulk the lesion).

Figure 6

Preoperative and postoperative neuroradiology workup in 12 years old patient undergoing interhemispheric approach and callosotomy for debulking of Left thalamic glioma (Left image, Coronal FLAIR showing the hyperintense lesion originating from Left thalamus and invading the ventricular space with obstruction of foramens of Monro; Right image, Coronal contrast-enhanced T1WI showing some blood-related ependymal enhancement in the surgical cavity following complete resection of the lesion).

Figure 7

Preoperative and postoperative neuroradiology workup in 9 years old patient with Chiari 1 malformation (CM-1) (Left image, sagittal T1WI MRI showing a typical overcrowded posterior fossa with cerebellar ectopia through the foramen magnum down to the level of C3 and evidence of syringomyelia in the cervical spinal cord; Right image, sagittal CT scan showing mild proptosis of the cerebellum through the posterior fossa decompression without evidence of postoperative pseudomeningocele).

Figure 8

Postoperative CT appearance of misplaced intraparenchymal probe for intracranial pressure monitoring (Right image, coronal bone window CT scan showing the probe close to the lamina cribrosa; Left image, sagittal plain CT scan showing the trajectory of the probe toward the floor of anterior fossa).