Early postoperative magnetic resonance imaging following nonneoplastic cortical resection

View More View Less
  • 1 Departments of Neurological Surgery and Radiology (Neuroradiology), Washington University School of Medicine, St. Louis, Missouri
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ Postcraniotomy residual tumor is often determined by magnetic resonance (MR) imaging. Magnetic resonance changes that occur in the postoperative setting must be defined to ensure both the optimum timing of postoperative image acquisition and the accurate assessment of images for residual tumor. Postoperative changes in nontumor parenchyma have previously been described for computerized tomography but not for MR imaging. In the present study, 11 patients without intracranial neoplastic disease (six females and five males with a median age of 36 years) submitted to MR imaging 17 to 28 hours after undergoing temporal lobectomies for epilepsy. Four of the operations were performed with the patients under general anesthesia and seven under local anesthesia. Postoperative MR images (T1-weighted, T1-weighted gadolinium enhanced, and T2-weighted) were reviewed. Extraaxial fluid, air, or blood was present in all cases. Enhancement of the resection bed parenchyma occurred in seven (64%) of 11 patients. In three of the remaining four patients, assessment of parenchymal enhancement was obscured by extraaxial fluid collections. Dural enhancement occurred adjacent to the resection site in all of the cases and remotely in 73%. Eight (73%) of 11 patients displayed enhancement of the pia-arachnoid of the ipsilateral cerebral convexity, two (18%) of the contralateral convexity, and four (36%) of the pia-arachnoid overlying the cerebellum. Contrary to previous reports, contrast enhancement of nonneoplastic human brain parenchyma can occur postoperatively within 17 hours. Benign parenchymal contrast enhancement is usually linear in appearance; non-neoplastic dural and leptomeningeal enhancement can occur both adjacent to and distant from the surgical site. Extraaxial fluid collections can hinder MR evaluation of the resection bed.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Daniel L. Silbergeld, M.D., Department of Neurological Surgery, Washington University School of Medicine, Campus Box 8057, 660 South Euclid Avenue, St. Louis, Missouri 63110–1093.
  • 1.

    Ahmadi J, , Hinton DR, & Segall HD, et al: Surgical implications of magnetic resonance-enhanced dura. Neurosurgery 35:370377, 1994 Ahmadi J, Hinton DR, Segall HD, et al: Surgical implications of magnetic resonance-enhanced dura. Neurosurgery 35:370–377, 1994

    • Search Google Scholar
    • Export Citation
  • 2.

    Albert FK, , Forsting M, & Sartor K, et al: Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34:4561, 1994 Albert FK, Forsting M, Sartor K, et al: Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34:45–61, 1994

    • Search Google Scholar
    • Export Citation
  • 3.

    Ammirati M, , Vick N, & Liao Y, et al: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21:201206, 1987 Ammirati M, Vick N, Liao Y, et al: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21:201–206, 1987

    • Search Google Scholar
    • Export Citation
  • 4.

    Andreou J, , George AE, & Wise A, et al: CT prognostic criteria of survival after malignant glioma surgery. AJNR 4:488490, 1983 Andreou J, George AE, Wise A, et al: CT prognostic criteria of survival after malignant glioma surgery. AJNR 4:488–490, 1983

    • Search Google Scholar
    • Export Citation
  • 5.

    Bashir R, , Hochberg F, & Oot R: Regrowth patterns of glioblastoma multiforme related to planning of interstitial brachytherapy radiation fields. Neurosurgery 23:2730, 1988 Bashir R, Hochberg F, Oot R: Regrowth patterns of glioblastoma multiforme related to planning of interstitial brachytherapy radiation fields. Neurosurgery 23:27–30, 1988

    • Search Google Scholar
    • Export Citation
  • 6.

    Bronen RA, & Sze G: Magnetic resonance imaging contrast agents: theory and application to the central nervous system. J Neurosurg 73:820839, 1990 Bronen RA, Sze G: Magnetic resonance imaging contrast agents: theory and application to the central nervous system. J Neurosurg 73:820–839, 1990

    • Search Google Scholar
    • Export Citation
  • 7.

    Burger PC, , Heinz ER, & Shibata T, et al: Topographic anatomy and CT correlations in the untreated glioblastoma multiforme. J Neurosurg 68:698704, 1988 Burger PC, Heinz ER, Shibata T, et al: Topographic anatomy and CT correlations in the untreated glioblastoma multiforme. J Neurosurg 68:698–704, 1988

    • Search Google Scholar
    • Export Citation
  • 8.

    Cairncross JG, , Macdonald DR, & Pexman JHW, et al: Steroid-induced CT changes in patients with recurrent malignant glioma. Neurology 38:724726, 1988 Cairncross JG, Macdonald DR, Pexman JHW, et al: Steroid-induced CT changes in patients with recurrent malignant glioma. Neurology 38:724–726, 1988

    • Search Google Scholar
    • Export Citation
  • 9.

    Cairncross JG, , Pexman JHW, & Rathbone MP, et al: Postoperative contrast enhancement in patients with brain tumor. Ann Neurol 17:570572, 1985 Cairncross 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
  • 10.

    Ciric I, , Ammirati M, & Vick N, et al: Supratentorial gliomas: surgical considerations and immediate postoperative results. Gross total resection versus partial resection. Neurosurgery 21:2126, 1987 Ciric I, Ammirati M, Vick N, et al: Supratentorial gliomas: surgical considerations and immediate postoperative results. Gross total resection versus partial resection. Neurosurgery 21:21–26, 1987

    • Search Google Scholar
    • Export Citation
  • 11.

    Crocker EF, , Zimmerman RA, & Phelps ME, et al: The effect of steroids on the extravascular distribution of radiographic contrast material and technetium pertechnetate in brain tumors as determined by computed tomography. Radiology 119:471474, 1976 Crocker EF, Zimmerman RA, Phelps ME, et al: The effect of steroids on the extravascular distribution of radiographic contrast material and technetium pertechnetate in brain tumors as determined by computed tomography. Radiology 119:471–474, 1976

    • Search Google Scholar
    • Export Citation
  • 12.

    DiChiro G, , Brooks RA, & Girton ME, et al: Sequential MR imaging studies of intracerebral hematomas in monkeys. AJNR 7:193199, 1985 DiChiro G, Brooks RA, Girton ME, et al: Sequential MR imaging studies of intracerebral hematomas in monkeys. AJNR 7:193–199, 1985

    • Search Google Scholar
    • Export Citation
  • 13.

    Dickman CA, , Rekate HL, & Bird CR, et al: Unenhanced and gadolinium-DTPA-enhanced MR imaging in postoperative evaluation in pediatric brain tumors. J Neurosurg 71:4953, 1989 Dickman CA, Rekate HL, Bird CR, et al: Unenhanced and gadolinium-DTPA-enhanced MR imaging in postoperative evaluation in pediatric brain tumors. J Neurosurg 71:49–53, 1989

    • Search Google Scholar
    • Export Citation
  • 14.

    Elster AD, & DiPersio DA: Cranial postoperative site: assessment with contrast-enhanced MR imaging. Radiology 174:9398, 1990 Elster AD, DiPersio DA: Cranial postoperative site: assessment with contrast-enhanced MR imaging. Radiology 174:93–98, 1990

    • Search Google Scholar
    • Export Citation
  • 15.

    Elster AD, , Jackels SC, & Allen NS, et al: Dyke Award. Europium-DTPA: a gadolinium analogue traceable by fluorescence microscopy. AJNR 10:11371144, 1989 Elster AD, Jackels SC, Allen NS, et al: Dyke Award. Europium-DTPA: a gadolinium analogue traceable by fluorescence microscopy. AJNR 10:1137–1144, 1989

    • Search Google Scholar
    • Export Citation
  • 16.

    Elster AD, & Moody DM: Early cerebral infarction: gadopentetate dimeglumine enhancement. Neuroradiology 177:627632, 1990 Elster AD, Moody DM: Early cerebral infarction: gadopentetate dimeglumine enhancement. Neuroradiology 177:627–632, 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    Gado MH, , Phelps ME, & Coleman RE: An extravascular component of contrast enhancement in cranial computed tomography. Radiology 117:589593, 1975 Gado 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
  • 18.

    Hitchcock E, & Sato F: Treatment of malignant gliomata. J Neurosurg 21:497505, 1964 Hitchcock E, Sato F: Treatment of malignant gliomata. J Neurosurg 21:497–505, 1964

    • Search Google Scholar
    • Export Citation
  • 19.

    Hochberg FH, & Pruitt A: Assumptions in the radiotherapy of glioblastoma. Neurology 30:907911, 1980 Hochberg FH, Pruitt A: Assumptions in the radiotherapy of glioblastoma. Neurology 30:907–911, 1980

    • Search Google Scholar
    • Export Citation
  • 20.

    Höllerhage HG, , Zumkeller M, & Becker M, et al: Influence of type and extent of surgery on early results and survival time in glioblastoma multiforme. Acta Neurochir 113:3137, 1991 Höllerhage HG, Zumkeller M, Becker M, et al: Influence of type and extent of surgery on early results and survival time in glioblastoma multiforme. Acta Neurochir 113:31–37, 1991

    • Search Google Scholar
    • Export Citation
  • 21.

    Jeffries BF, , Kishore PRS, & Singh KS, et al: Contrast enhancement in the postoperative brain. Radiology 139:409413, 1981 Jeffries BF, Kishore PRS, Singh KS, et al: Contrast enhancement in the postoperative brain. Radiology 139:409–413, 1981

    • Search Google Scholar
    • Export Citation
  • 22.

    Jelsma R, & Bucy PC: Glioblastoma multiforme. Its treatment and some factors effecting survival. Arch Neurol 20:161171, 1969 Jelsma R, Bucy PC: Glioblastoma multiforme. Its treatment and some factors effecting survival. Arch Neurol 20:161–171, 1969

    • Search Google Scholar
    • Export Citation
  • 23.

    Kinsella TJ, , Collins J, & Rowland J, et al: Pharmacology and phase I/II study of continuous intravenous infusions of iododeoxyuridine and hyperfractionated radiotherapy in patients with glioblastoma multiforme. J Clin Oncol 6:871879, 1988 Kinsella TJ, Collins J, Rowland J, et al: Pharmacology and phase I/II study of continuous intravenous infusions of iododeoxyuridine and hyperfractionated radiotherapy in patients with glioblastoma multiforme. J Clin Oncol 6:871–879, 1988

    • Search Google Scholar
    • Export Citation
  • 24.

    Lanzieri CF, , Larkins M, & Mancall A, et al: Cranial postoperative site: MR imaging appearance. AJNR 9:2734, 1988 Lanzieri CF, Larkins M, Mancall A, et al: Cranial postoperative site: MR imaging appearance. AJNR 9:27–34, 1988

    • Search Google Scholar
    • Export Citation
  • 25.

    Laohaprasit V, , Silbergeld DL, & Ojemann GA, et al: Postoperative CT contrast enhancement following lobectomy for epilepsy. J Neurosurg 73:392395, 1990 Laohaprasit V, Silbergeld DL, Ojemann GA, et al: Postoperative CT contrast enhancement following lobectomy for epilepsy. J Neurosurg 73:392–395, 1990

    • Search Google Scholar
    • Export Citation
  • 26.

    Meyding-Lamadé U, , Forsting M, & Albert F, et al: Accelerated methaemoglobin formation: potential pitfall in early postoperative MRI. Neuroradiology 35:178180, 1993 Meyding-Lamadé U, Forsting M, Albert F, et al: Accelerated methaemoglobin formation: potential pitfall in early postoperative MRI. Neuroradiology 35:178–180, 1993

    • Search Google Scholar
    • Export Citation
  • 27.

    Nazzaro JM, & Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg 73:331344, 1990 Nazzaro JM, Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg 73:331–344, 1990

    • Search Google Scholar
    • Export Citation
  • 28.

    Newall J, , Ransohoff J, & Kaplan B: Glioblastoma in the older patient: how long a course of radiotherapy is necessary? J Neurooncol 6:325327, 1988 Newall J, Ransohoff J, Kaplan B: Glioblastoma in the older patient: how long a course of radiotherapy is necessary? J Neurooncol 6:325–327, 1988

    • Search Google Scholar
    • Export Citation
  • 29.

    Ojemann GA: Surgical therapy for medically intractable epilepsy. J Neurosurg 66:489499, 1987 Ojemann GA: Surgical therapy for medically intractable epilepsy. J Neurosurg 66:489–499, 1987

    • Search Google Scholar
    • Export Citation
  • 30.

    Penn RD, , Walser R, & Kurtz D, et al: Tumor volume, luxury perfusion, and regional blood volume changes in man visualized by subtraction computerized tomography. J Neurol 44:449457, 1976 Penn RD, Walser R, Kurtz D, et al: Tumor volume, luxury perfusion, and regional blood volume changes in man visualized by subtraction computerized tomography. J Neurol 44:449–457, 1976

    • Search Google Scholar
    • Export Citation
  • 31.

    Roth JG, & Elvidge AR: Glioblastoma multiforme: a clinical survey. J Neurosurg 17:736750, 1960 Roth JG, Elvidge AR: Glioblastoma multiforme: a clinical survey. J Neurosurg 17:736–750, 1960

    • Search Google Scholar
    • Export Citation
  • 32.

    Runge VM, , Clanton JA, & Price AC, et al: Dyke Award. Evaluation of contrast-enhanced MR imaging in a brain-abscess model. AJNR 6:139147, 1985 Runge VM, Clanton JA, Price AC, et al: Dyke Award. Evaluation of contrast-enhanced MR imaging in a brain-abscess model. AJNR 6:139–147, 1985

    • Search Google Scholar
    • Export Citation
  • 33.

    Salcman M: Surgical decision-making for malignant brain tumors. Clin Neurosurg 35:285313, 1987 Salcman M: Surgical decision-making for malignant brain tumors. Clin Neurosurg 35:285–313, 1987

    • Search Google Scholar
    • Export Citation
  • 34.

    Salcman M: Survival in glioblastoma: historical perspective. Neurosurgery 7:435439, 1980 Salcman M: Survival in glioblastoma: historical perspective. Neurosurgery 7:435–439, 1980

    • Search Google Scholar
    • Export Citation
  • 35.

    Salcman M, , Levine H, & Rao K: Value of sequential computed tomography in the multimodality treatment of glioblastoma multiforme. Neurosurgery 8:1519, 1981 Salcman M, Levine H, Rao K: Value of sequential computed tomography in the multimodality treatment of glioblastoma multiforme. Neurosurgery 8:15–19, 1981

    • Search Google Scholar
    • Export Citation
  • 36.

    Scanlon PW, & Taylor WF: Radiotherapy of intracranial astrocytomas: analysis of 417 cases treated from 1960 through 1969. Neurosurgery 5:301308, 1979 Scanlon PW, Taylor WF: Radiotherapy of intracranial astrocytomas: analysis of 417 cases treated from 1960 through 1969. Neurosurgery 5:301–308, 1979

    • Search Google Scholar
    • Export Citation
  • 37.

    Shapiro WR: Treatment of neuroectodermal brain tumors. Ann Neurol 12:231237, 1982 Shapiro WR: Treatment of neuroectodermal brain tumors. Ann Neurol 12:231–237, 1982

    • Search Google Scholar
    • Export Citation
  • 38.

    Silbergeld DL, & Ojemann GA: The tailored temporal lobectomy. Neurosurg Clin N Am 4:273281, 1993 Silbergeld DL, Ojemann GA: The tailored temporal lobectomy. Neurosurg Clin N Am 4:273–281, 1993

    • Search Google Scholar
    • Export Citation
  • 39.

    Sze G: New applications of MR contrast agents in neuroradiology. Neuroradiology 32:421438, 1990 Sze G: New applications of MR contrast agents in neuroradiology. Neuroradiology 32:421–438, 1990

    • Search Google Scholar
    • Export Citation
  • 40.

    Vecht CJ, , Avezaat CJJ, & van Putten WLJ, et al: The influence of the extent of surgery on the neurological function and survival in malignant glioma. A retrospective analysis in 243 patients. J Neurol Neurosurg Psychiatry 53:466471, 1990 Vecht CJ, Avezaat CJJ, van Putten WLJ, et al: The influence of the extent of surgery on the neurological function and survival in malignant glioma. A retrospective analysis in 243 patients. J Neurol Neurosurg Psychiatry 53:466–471, 1990

    • Search Google Scholar
    • Export Citation
  • 41.

    Vick NA, , Ciric IS, & Eller TW, et al: Reoperation for malignant astrocytoma. Neurology 39:430432, 1989 Vick NA, Ciric IS, Eller TW, et al: Reoperation for malignant astrocytoma. Neurology 39:430–432, 1989

    • Search Google Scholar
    • Export Citation
  • 42.

    Wakai S, , Andoh Y, & Ochiai C, et al: Postoperative contrast enhancement in brain tumors and intracerebral hematomas: CT study. J Comput Assist Tomogr 14:267271, 1990 Wakai S, Andoh Y, Ochiai C, et al: Postoperative contrast enhancement in brain tumors and intracerebral hematomas: CT study. J Comput Assist Tomogr 14:267–271, 1990

    • Search Google Scholar
    • Export Citation
  • 43.

    Weir B: The relative significance of factors affecting postoperative survival in astrocytomas, grades 3 and 4. J Neurosurg 38:448452, 1973 Weir B: The relative significance of factors affecting postoperative survival in astrocytomas, grades 3 and 4. J Neurosurg 38:448–452, 1973

    • Search Google Scholar
    • Export Citation
  • 44.

    Wood JR, , Green SB, & Shapiro WR: The prognostic importance of tumor size in malignant gliomas: a computed tomographic image study by the Brain Tumor Cooperative Group. J Clin Oncol 6:338343, 1988 Wood JR, Green SB, Shapiro WR: The prognostic importance of tumor size in malignant gliomas: a computed tomographic image study by the Brain Tumor Cooperative Group. J Clin Oncol 6:338–343, 1988

    • Search Google Scholar
    • Export Citation
  • 45.

    Zagzag D, , Goldenberg M, & Brem S: Angiogenesis and blood-brain barrier breakdown modulate CT contrast enhancement: an experimental study in a rabbit brain-tumor model. AJNR 10:529534, 1989 Zagzag D, Goldenberg M, Brem S: Angiogenesis and blood-brain barrier breakdown modulate CT contrast enhancement: an experimental study in a rabbit brain-tumor model. AJNR 10:529–534, 1989

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 358 116 2
Full Text Views 149 1 0
PDF Downloads 89 1 0
EPUB Downloads 0 0 0