Postoperative CT contrast enhancement following lobectomy for epilepsy

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✓ Contrast-enhanced computerized tomography (CT) is frequently utilized immediately after surgery to determine the presence of residual tumor, but the response of nontumor brain tissue is unclear. Consequently, the authors investigated the postoperative CT contrast enhancement in six patients undergoing lobectomy for epilepsy. Preoperative CT scans were obtained in all cases and revealed no enhancing lesions. All patients underwent craniotomy with electrocorticography while awake, followed by lobectomy. Computerized tomography scans with and without administration of contrast material were obtained on postoperative Days 3, 7, and 30. Edema, artifact, and enhancement of the resection margins were seen on postoperative Days 3 and 7, but had resolved in all patients by Day 30. It is concluded that postoperative CT scans for assessment of residual tumor are best obtained at 30 days or thereafter, when normal brain does not enhance and edema and artifact have diminished.

Article Information

Address reprint requests to: George A. Ojemann, M.D., Department of Neurological Surgery RI-20, University of Washington, Seattle, Washington 98195.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 2. A and B: Computerized tomography scans with (A) and without (B) contrast material, obtained 7 days postoperatively showing edema and enhancement of the resection margin (arrows). C: Scan with contrast enhancement obtained on the 30th postoperative day showing resolution of edema and enhancement (arrows).

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    Case 5. Computerized tomography scans without (left) and with (right) contrast material. A and B: Scans obtained 3 days after surgery showing edema, enhancement, and a small amount of blood in the resection margins (arrows). C and D: Scans showing persistence of these changes on postoperative Day 7 (arrows). E and F: Scans obtained 30 days after surgery showing resolution of the operative changes.

References

  • 1.

    Ambrose J: Computerized transverse axial scanning (tomography): Part 2. Clinical application. Br J Radiol 46:102310471973Ambrose J: Computerized transverse axial scanning (tomography): Part 2. Clinical application. Br J Radiol 46:1023–1047 1973

    • Search Google Scholar
    • Export Citation
  • 2.

    Cairncross JGPexman JHWRathbone MP: Post-surgical contrast enhancement mimicking residual brain tumour. Can Sci Neurol 12:751985 (Letter)Cairncross JG Pexman JHW Rathbone MP: Post-surgical contrast enhancement mimicking residual brain tumour. Can Sci Neurol 12:75 1985 (Letter)

    • Search Google Scholar
    • Export Citation
  • 3.

    Cairncross JGPexman JHWRathbone MPet al: Postoperative contrast enhancement in patients with brain tumor. Ann Neurol 17:5705721985Cairncross JG Pexman JHW Rathbone MP et al: Postoperative contrast enhancement in patients with brain tumor. Ann Neurol 17:570–572 1985

    • Search Google Scholar
    • Export Citation
  • 4.

    Davis KRTaveras JMNew PFJet al: Cerebral infarction diagnosis by computed tomography, analysis and evaluation of findings. AJR 124:6436601975Davis KR Taveras JM New PFJ et al: Cerebral infarction diagnosis by computed tomography analysis and evaluation of findings. AJR 124:643–660 1975

    • Search Google Scholar
    • Export Citation
  • 5.

    Enzmann DRBritt RHYearger AS: Experimental brain abscess evolution: computed tomographic and neuropathologic correlation. Radiology 133:1131221979Enzmann DR Britt RH Yearger AS: Experimental brain abscess evolution: computed tomographic and neuropathologic correlation. Radiology 133:113–122 1979

    • Search Google Scholar
    • Export Citation
  • 6.

    Feely MPDempsey PJ: Assessment of the postoperative course of excised brain abscess by computerized tomography. Neurosurgery 5:49521979Feely MP Dempsey PJ: Assessment of the postoperative course of excised brain abscess by computerized tomography. Neurosurgery 5:49–52 1979

    • Search Google Scholar
    • Export Citation
  • 7.

    Gado MHPhelps MEColeman RE: An extravascular component of contrast enhancement in cranial computed tomography. Radiology 117:5895931975Gado MH Phelps ME Coleman RE: An extravascular component of contrast enhancement in cranial computed tomography. Radiology 117:589–593 1975

    • Search Google Scholar
    • Export Citation
  • 8.

    Gerber AMSavolaine ER: Modification of tumor enhancement and brain edema in computerized tomography by corticosteroids: case report. Neurosurgery 6:2822841980Gerber AM Savolaine ER: Modification of tumor enhancement and brain edema in computerized tomography by corticosteroids: case report. Neurosurgery 6:282–284 1980

    • Search Google Scholar
    • Export Citation
  • 9.

    Grand WKinkel WRGlasauer FEet al: Ring formation on computerized tomography in the postoperative patient. Neurosurgery 2:1071091978Grand W Kinkel WR Glasauer FE et al: Ring formation on computerized tomography in the postoperative patient. Neurosurgery 2:107–109 1978

    • Search Google Scholar
    • Export Citation
  • 10.

    Groothuis DRMolnar PBlasberg RG: Regional blood flow and blood-to-tissue transport in five brain tumor models. Prog Exp Tumor Res 27:1321531984Groothuis DR Molnar P Blasberg RG: Regional blood flow and blood-to-tissue transport in five brain tumor models. Prog Exp Tumor Res 27:132–153 1984

    • Search Google Scholar
    • Export Citation
  • 11.

    Hatam ABergström MYu ZYet al: Effect of dexamethasone treatment in volume and contrast enhancement of intracranial neoplasms. J Comput Assist Tomogr 7:2953001983Hatam A Bergström M Yu ZY et al: Effect of dexamethasone treatment in volume and contrast enhancement of intracranial neoplasms. J Comput Assist Tomogr 7:295–300 1983

    • Search Google Scholar
    • Export Citation
  • 12.

    Jeffries BFKishore PRSSingh KSet al: Contrast enhancement in the postoperative brain. Neuroradiology 139:4094131981Jeffries BF Kishore PRS Singh KS et al: Contrast enhancement in the postoperative brain. Neuroradiology 139:409–413 1981

    • Search Google Scholar
    • Export Citation
  • 13.

    Krishna Rao CVGKishore PRSBarlett Jet al: Computed tomography in the postoperative patient. Neuroradiology 19:2572631980Krishna Rao CVG Kishore PRS Barlett J et al: Computed tomography in the postoperative patient. Neuroradiology 19:257–263 1980

    • Search Google Scholar
    • Export Citation
  • 14.

    Laster DWMoody DMBall MR: Resolving intracerebral hematoma: alteration of the “ring sign” with steroids. AJR 130:9359391978Laster DW Moody DM Ball MR: Resolving intracerebral hematoma: alteration of the “ring sign” with steroids. AJR 130:935–939 1978

    • Search Google Scholar
    • Export Citation
  • 15.

    Levin VACrafts DCNorman DMet al: Criteria for evaluating patients undergoing chemotherapy for malignant brain tumors. J Neurosurg 47:3293351977Levin VA Crafts DC Norman DM et al: Criteria for evaluating patients undergoing chemotherapy for malignant brain tumors. J Neurosurg 47:329–335 1977

    • Search Google Scholar
    • Export Citation
  • 16.

    Lin JPPay NNaidich TPet al: Computed tomography in the postoperative care of neurosurgical patients. Neuroradiology 12:1851891977Lin JP Pay N Naidich TP et al: Computed tomography in the postoperative care of neurosurgical patients. Neuroradiology 12:185–189 1977

    • Search Google Scholar
    • Export Citation
  • 17.

    Messina AV: Computed tomography: contrast-enhancement in resolving intracerebral hemorrhage. AJR 127:105010521976Messina AV: Computed tomography: contrast-enhancement in resolving intracerebral hemorrhage. AJR 127:1050–1052 1976

    • Search Google Scholar
    • Export Citation
  • 18.

    Ojemann GA: Basic mechanisms implicated in surgical treatments of epilepsy in Lockard JSWard AA Jr (eds): Epilepsy: A Window to Brain Mechanisms. New York: Raven Press1980 pp 261277Ojemann GA: Basic mechanisms implicated in surgical treatments of epilepsy in Lockard JS Ward AA Jr (eds): Epilepsy: A Window to Brain Mechanisms. New York: Raven Press 1980 pp 261–277

    • Search Google Scholar
    • Export Citation
  • 19.

    Ojemann GA: Neurosurgical management of epilepsy: a personal perspective in 1983. Appl Neurophysiol 46:11181983Ojemann GA: Neurosurgical management of epilepsy: a personal perspective in 1983. Appl Neurophysiol 46:11–18 1983

    • Search Google Scholar
    • Export Citation
  • 20.

    Ojemann GA: Surgical therapy for medically intractable epilepsy. J Neurosurg 66:4894991987Ojemann GA: Surgical therapy for medically intractable epilepsy. J Neurosurg 66:489–499 1987

    • Search Google Scholar
    • Export Citation
  • 21.

    Ojemann GA: Surgical treatment of epilepsy in Wilkins RHRengachary SS (eds): Neurosurgery. New York: McGraw-Hill1985 Vol 3 pp 25172526Ojemann GA: Surgical treatment of epilepsy in Wilkins RH Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill 1985 Vol 3 pp 2517–2526

    • Search Google Scholar
    • Export Citation
  • 22.

    Ojemann LMOjemann GA: Treatment of epilepsy. Am Fam Physician 30:1131281984Ojemann LM Ojemann GA: Treatment of epilepsy. Am Fam Physician 30:113–128 1984

    • Search Google Scholar
    • Export Citation
  • 23.

    Penn RDWalser RKurtz Det al: Tumor volume, luxury perfusion, and regional blood volume changes in man visualized by subtraction computerized tomography. J Neurosurg 44:4494571976Penn RD Walser R Kurtz D et al: Tumor volume luxury perfusion and regional blood volume changes in man visualized by subtraction computerized tomography. J Neurosurg 44:449–457 1976

    • Search Google Scholar
    • Export Citation
  • 24.

    Salcman MKaplan RSDucker TBet al: Effect of age and reoperation on survival in the combined modality treatment of malignant astrocytoma. Neurosurgery 10:4544631982Salcman M Kaplan RS Ducker TB et al: Effect of age and reoperation on survival in the combined modality treatment of malignant astrocytoma. Neurosurgery 10:454–463 1982

    • Search Google Scholar
    • Export Citation
  • 25.

    Sheline GE: Irradiation injury of the human brain: a review of clinical experience in Gilbert HAKagan AR (eds): Radiation Damage to the Nervous System. New York: Raven Press1980 pp 3958Sheline GE: Irradiation injury of the human brain: a review of clinical experience in Gilbert HA Kagan AR (eds): Radiation Damage to the Nervous System. New York: Raven Press 1980 pp 39–58

    • Search Google Scholar
    • Export Citation
  • 26.

    Sheline GEWara WMSmith V: Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys 6:121512281980Sheline GE Wara WM Smith V: Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys 6:1215–1228 1980

    • Search Google Scholar
    • Export Citation
  • 27.

    Troiano RHafstein MRuderman Met al: Effect of high dose intravenous steroid administration on contrast-enhancing computed tomographic scan lesions in multiple sclerosis. Ann Neurol 15:2572631984Troiano R Hafstein M Ruderman M et al: Effect of high dose intravenous steroid administration on contrast-enhancing computed tomographic scan lesions in multiple sclerosis. Ann Neurol 15:257–263 1984

    • Search Google Scholar
    • Export Citation
  • 28.

    Wortzman G: Computerized transaxial tomography: its role in the post-operative tumor case. J Can Sci Neurol 3:51581976Wortzman G: Computerized transaxial tomography: its role in the post-operative tumor case. J Can Sci Neurol 3:51–58 1976

    • Search Google Scholar
    • Export Citation
  • 29.

    Yock DHMarshall WH: Recent ischemic brain infarcts on computed tomography: appearances pre- and postcontrast infusion. Radiology 117:5996081975Yock DH Marshall WH: Recent ischemic brain infarcts on computed tomography: appearances pre- and postcontrast infusion. Radiology 117:599–608 1975

    • Search Google Scholar
    • Export Citation
  • 30.

    Zimmerman RDLeeds NENaidich TP: Ring blush associated with intracerebral hematoma. Radiology 122:7077111977Zimmerman RD Leeds NE Naidich TP: Ring blush associated with intracerebral hematoma. Radiology 122:707–711 1977

    • Search Google Scholar
    • Export Citation

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