The Value of Postoperative Brain Scan in Patients with Supratentorial Intracranial Tumors

Abstract

I F A brain tumor recurs af ter a primary resection, as most gliomas do, the recurrence probably has s tar ted before the pat ient leaves the operat ing room. During the ensuing months and years, the recurrent neoplasm grows and eventual ly produces seizures, headaches, or o ther symptoms and signs tha t indicate its presence. However, some of the same symptoms and signs can be produced by postoperat ive gliosis, fibrosis, hydrocephalus, and vascular insufficiency, and the diagnosis of significant tumor recurrence may be difficult to establish by history and physical examinat ion in the early stages. 1' Because of these processes and the mechanical distortions produced by the operation, electroencephalography, echoencephalography, and plain roentgenography may also be of little value. Until recently, the clinician evaluating the initial evidences of recurrence has been faced with the choice of waiting for fur ther manifestations or of subjecting his pat ient to the expense and inconvenience of hospitalization and to the discomfort and risks of angiography, pneumoencephalography, or ventriculography. Fur the r delay is perhaps of little importance in pat ients with malignant gliomas, but in pat ients with benign tumors it may result in significant neurological damage that could have been prevented. This situation has been improved greatly by the development of two new diagnostic procedures. The first employs tanta lum powder, which is sprinkled along the zone of resection at the conclusion of the primary tumor removal. The subsequent displacement of this t an ta lum powder by the enlarging neoplasm then can be demonstrated roentgenographically. 6,9 The second pro-