Article
Is there a role for early postoperative MRI after resection of brain metastases?
Gibt es einen Stellenwert für die früh-postoperative MRT nach intrakranieller Metastasenresektion?
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Authors
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Neda Mokhtari
- Evangelisches Krankenhaus der Stiftung Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Björn Berger
- Evangelisches Klinikum Bethel, Klinik für Neuroradiologie, Bielefeld, Deutschland
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Matthias Simon
- Evangelisches Krankenhaus der Stiftung Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Alexander Grote
- Evangelisches Krankenhaus der Stiftung Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: While glioma patients routinely undergo early postoperative MRI, the role of postoperative and in particular MR imaging following surgery for brain metastases is not clear. In the present study, we have therefore reviewed our institutional experience with early routine postoperative MRI after metastasectomy.
Methods: Pertinent demographic, clinical and imaging data from 230 consecutive adult patients undergoing surgery for brain metastases between 01/2016 and 10/2019 were retrospectively analyzed. In 96 cases early postoperative MRI was performed within the first 72 hours after surgery. Residual tumor was categorized using the RANO criteria as follows: "no residual tumor", "non-measurable residual tumor" and "measurable residual tumor".
Results: 54 (56.3%) patients were female and median age was 58.1 years. The most frequent primary tumor sites were lung and breast (respectively 39 [40.6%]; 17 [17.7%]). 63 (65.6%) patients had a single metastasis. 19 (19.7%) cases were diagnosed with 2 and 14 (14.6%) with 33 metastases. Postoperative MR imaging revealed no hemorrhagic or other complication requiring revision surgery, but 9 (9.4%) ischemias resulting from perforator or small vessel occlusion, and cerebral venous sinus thrombosis in 5 (5.2%) patients. "Measurable residual tumor" was identified in 12 patients (12.5%). Four of these patients had a second surgery and resection of the tumor remnant. "Non-measurable residual tumor" was seen in 17 cases (17.7 %), i.e. a complete resection proven by postoperative imaging was performed in only 67 procedures (69.8 %). The postoperative MRI study showed residual tumor in 19/91 (20.9%; 7 measurable, 12 non-measurable) patients who had a presumably complete resection according to the operating surgeon’s impression. Median follow up was 9.4 months. Residual tumor had no statistically significant impact on overall survival.
Conclusion: Routine postoperative MR imaging following resection of brain metastases might have some value for the diagnosis and management of vascular complications. Importantly, early postoperative MRI identifies a surprisingly large number of cases with unexpected incomplete resections. Future studies will have to define a potential impact of residual tumor on patient survival.
