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Postoperative CT scans after resection of brain metastases: neurosurgical routine or added value?

  • Clinical Study
  • Published:
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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.

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Data availability

Raw data used in the analysis is presented in the Supplemental Table.

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Funding

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Authors and Affiliations

  1. Department of Neurosurgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada

    Kaiyun Yang, Alexander P. Landry, Matthias Millesi, Matheuss Leite, Aristotelis Kalyvas, Mark Bernstein, Gelareh Zadeh & Paul N. Kongkham

  2. Department of Neurosurgery, McMaster University, Hamilton, ON, Canada

    Majid Aljoghaiman

  3. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Enrique Gutierrez, Paola Anna Jablonska, Barbara-Ann Millar, Tatianna Conrad, Normand Laperriere & David Shultz

  4. Department of Neurosurgery, Medical University of Vienna, Vienna, Austria

    Matthias Millesi

  5. Medical Library, North Shore University Hospital, Manhasset, NY, USA

    Jaclyn Vialet

  6. Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Jessica Weiss

Authors
  1. Kaiyun Yang
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  2. Alexander P. Landry
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  14. Mark Bernstein
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  15. Gelareh Zadeh
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Contributions

Study design: KY, MA and PK. Data collection: KY, AL, EG and DS. Literature review: KY, MA and JV. Data interpretation: KY, JW, NL, MB, MM, DS, PK. Writing: KY, EG, AL, MM, PAJ, JW, NL, MB, DS, PK. Critical review and approval of the final version: all authors.

Corresponding authors

Correspondence to Alexander P. Landry or Paul N. Kongkham.

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Yang, K., Landry, A.P., Aljoghaiman, M. et al. Postoperative CT scans after resection of brain metastases: neurosurgical routine or added value?. J Neurooncol 157, 157–163 (2022). https://doi.org/10.1007/s11060-022-03957-1

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  • DOI: https://doi.org/10.1007/s11060-022-03957-1

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