Alkhalili Kenan, Zenonos Georgios, Tataryn Zachary, Amankulor Nduka, Engh Johnathan
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
World Neurosurg. 2018 Mar;111:e206-e212. doi: 10.1016/j.wneu.2017.12.038. Epub 2017 Dec 16.
Scheduled early postoperative computed tomography (EPOCT) after craniotomy for brain tumor resection is standard at many institutions. We analyzed utility of preplanned EPOCT after elective craniotomy for brain tumor resection.
We retrospectively analyzed 755 brain tumor resections for which EPOCT was performed within 4 hours of surgery. Postoperative clinical neurologic examination results were classified into expected (baseline or predicted postoperative examination), changed (from baseline examination), and unreliable (sedated or baseline comatose patient). Scans were analyzed for unexpected and/or worrisome findings (e.g., hemorrhagic or ischemic stroke). In cases of unexpected findings, management changes were correlated to patient's neurologic examination. Demographic information, tumor histology, and tumor location were analyzed to determine risk factors for unexpected findings.
Rate of unexpected EPOCT findings was 4.1%. Patients with expected postoperative examinations were at significantly lower risk of abnormal findings (odds ratio [OR] = 0.074, P < 0.001). Patients with intraventricular tumors (OR = 5.7, P = 0.001) were at higher risk compared with patients with metastatic tumors (OR = 0.24, P = 0.06). No unexpected EPOCT findings led to management changes in patients with expected postoperative neurologic examinations. All unexpected EPOCT findings in patients with changed postoperative neurologic examinations led to management changes. Patients with nonreliable neurologic examinations were at significantly higher risk for unexpected findings on EPOCT (OR = 6.33, P < 0.001) and subsequent management changes.
Routine EPOCT is not indicated for patients undergoing brain tumor resection if postoperative neurologic examination is unchanged, as imaging is unlikely to result in management changes. EPOCT should be obtained in all patients with worrisome changes in examination or nonreliable examinations, as both groups have high rates of unexpected findings on imaging that lead to management changes.
在许多机构，脑肿瘤切除术后早期计划行计算机断层扫描（EPOCT）是标准操作。我们分析了择期脑肿瘤切除术后预先计划的EPOCT的效用。
我们回顾性分析了755例脑肿瘤切除术，这些手术在术后4小时内进行了EPOCT。术后临床神经学检查结果分为预期（基线或预测的术后检查）、改变（与基线检查相比）和不可靠（镇静或基线昏迷患者）。分析扫描结果以查找意外和/或令人担忧的发现（例如出血性或缺血性中风）。在出现意外发现的情况下，管理措施的改变与患者的神经学检查相关。分析人口统计学信息、肿瘤组织学和肿瘤位置，以确定意外发现的危险因素。
EPOCT意外发现率为4.1%。术后检查结果为预期的患者出现异常发现的风险显著较低（优势比[OR]=0.074，P<0.001）。与转移性肿瘤患者相比，脑室内肿瘤患者（OR=5.7，P=0.001）出现异常发现的风险更高。术后神经学检查结果为预期的患者中，没有意外的EPOCT发现导致管理措施改变。术后神经学检查结果改变的患者中，所有意外的EPOCT发现都导致了管理措施改变。神经学检查不可靠的患者在EPOCT上出现意外发现（OR=6.33，P<0.001）及随后管理措施改变的风险显著更高。
如果术后神经学检查没有变化，脑肿瘤切除术后的患者不建议常规进行EPOCT，因为影像学检查不太可能导致管理措施改变。所有检查结果令人担忧或检查不可靠的患者都应进行EPOCT，因为这两组患者影像学检查出现意外发现并导致管理措施改变的发生率都很高。
