gms | German Medical Science

Objective: Postoperative imaging (PI) is widely used after craniotomies for brain metastases (BM) without clear evidence of indication, utility or contribution to postoperative treatment. This causes an increase of cost of medical care and includes potential harmful exposure to radiation. The aim of this study is to investigate the usage, utility and yield of PI and its consequences for postoperative management.

Methods: A retrospective review including all craniotomies for BM performed at the investigators institution over a period of 5 years was performed. Details of radiologic imaging, indications and findings, as well as patient symptoms, primary tumor characteristics, hospital stay and treatment were collected.

Results: A total of 195 patients (mean age 60.2 years, range 18–90 years) underwent 202 craniotomies for BM. During their hospital stay 248 CT or MRI scans were performed postoperatively, among these 188 directly after surgery (115 CT, 73 MRI scans), resulting in 14 cases without PI (6.9%). Among the 188 cases of PI 36 (19.15%) were performed due to neurologic worsening or for further planning. Significant radiological findings were diagnosed in 11 of these 36 cases (30.56%) causing therapy changes in 4 of them (11.11%). The remaining 152 of 188 PI were performed routinely in asymptomatic patients (80.85%). Significant radiological findings were diagnosed in 8 of these 152 cases (4,60%), changing further therapy in 2 patients (0.013%).

Conclusion: Postoperative imaging after resection of BM is performed in many hospitals on a routine basis but remains with a very low yield when performed in the absence of neurological symptoms. Therefore, routine PI after resection of BM in asymptomatic patients can be dispensed. Nevertheless, in case of postoperative worsening performance of PI is mandatory.