Kaiyun Yang1, Alexander P Landry2, Majid Aljoghaiman3, Enrique Gutierrez4, Matthias Millesi1,5, Matheuss Leite1, Aristotelis Kalyvas1, Paola Anna Jablonska4, Jaclyn Vialet6, Jessica Weiss7, Barbara-Ann Millar4, Tatianna Conrad4, Normand Laperriere4, Mark Bernstein1, Gelareh Zadeh1, David Shultz4, Paul N Kongkham8. 1. Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada. 2. Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada. alex.landry@mail.utoronto.ca. 3. Department of Neurosurgery, McMaster University, Hamilton, ON, Canada. 4. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. 5. Department of Neurosurgery, Medical University of Vienna, Vienna, Austria. 6. Medical Library, North Shore University Hospital, Manhasset, NY, USA. 7. Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada. 8. Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada. paul.kongkham@uhn.ca.
Abstract
BACKGROUND: Metastasis is the most common brain tumor in adults. It is the standard of care at most North American centers to obtain an early postoperative imaging after their resection. However, the necessity of this practice in the absence of a new postoperative deficit remains unclear. METHODS: We retrospectively reviewed our surgical cohort of patients who underwent resection of brain metastases from July 2018 to June 2019. We collected demographic data and reviewed results of routine postoperative CT scans and neurological morbidities to examine the diagnostic and therapeutic yield of an early postoperative scan. In addition, we performed a systematic review of the topic. RESULTS: Our review included 130 patients, all of whom underwent gross total resection of one or more brain metastases. On postoperative CT, none had unexpected findings such as cavity hematoma or new ischemia; no changes in management resulted from postoperative imaging. One patient required a higher dose of dexamethasone on postoperative day 4 for delayed hemiparesis and aphasia due to cerebral edema. Three additional patients underwent a wound washout for delayed infection during a subsequent admission. Our systematic review identified three additional studies; in a combined cohort of 450 patients (including our own), no patients had clinically actionable findings on routine postoperative CT. CONCLUSIONS: Following resection of brain metastases, a routine postoperative CT scan has low diagnostic yield and did not change patient management in any cases examined in this work.
BACKGROUND: Metastasis is the most common brain tumor in adults. It is the standard of care at most North American centers to obtain an early postoperative imaging after their resection. However, the necessity of this practice in the absence of a new postoperative deficit remains unclear. METHODS: We retrospectively reviewed our surgical cohort of patients who underwent resection of brain metastases from July 2018 to June 2019. We collected demographic data and reviewed results of routine postoperative CT scans and neurological morbidities to examine the diagnostic and therapeutic yield of an early postoperative scan. In addition, we performed a systematic review of the topic. RESULTS: Our review included 130 patients, all of whom underwent gross total resection of one or more brain metastases. On postoperative CT, none had unexpected findings such as cavity hematoma or new ischemia; no changes in management resulted from postoperative imaging. One patient required a higher dose of dexamethasone on postoperative day 4 for delayed hemiparesis and aphasia due to cerebral edema. Three additional patients underwent a wound washout for delayed infection during a subsequent admission. Our systematic review identified three additional studies; in a combined cohort of 450 patients (including our own), no patients had clinically actionable findings on routine postoperative CT. CONCLUSIONS: Following resection of brain metastases, a routine postoperative CT scan has low diagnostic yield and did not change patient management in any cases examined in this work.