• Ronald J Benveniste, Raphael Yechieli, and Tejan Diwanji.
• Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: rbenveniste@med.miami.edu.
• World Neurosurg. 2021 Feb 1; 146: e1177-e1181.

BackgroundGamma knife radiosurgery (GKRS) is often performed to treat brain metastases (BrMs). Widely referenced guidelines have suggested post-treatment imaging studies at 3-month intervals. However, clinicians frequently obtain magnetic resonance imaging (MRI) studies at <3 months after GKRS.MethodsWe performed a retrospective medical record review study to assess the utility of early (<3 months) MRI after GKRS in patients with BrMs.ResultsA total of 415 GKRS procedures were performed. For 325 patients, early MRI studies were obtained. A total of 31 patients had new or worsened neurological symptoms. The early MRI studies showed adverse findings in 25 patients (78%), which in 23 (72%) had resulted in a change in treatment. For 294 patients, no new or worsened neurological symptoms were found on early MRI studies. Of these 294 patients, 86 (29%) had ≥1 adverse finding on MRI, and 60 (20%) had a change in management as a result. However, no rapidly growing tumors or other emergent adverse findings were seen.ConclusionsEarly MRI (within 3 months) after post GKRS will frequently show adverse findings even in asymptomatic patients, more often in patients aged <65 years and patients with multiple treated BrMs. However, according to the nature of the adverse findings observed in our retrospective study, it is unlikely that the clinical outcomes would have been affected if the post-GKRS MRI studies had been deferred to 3 months after treatment. Our data support deferring post-GKRS MRI to 3 months after treatment in the absence of new neurological signs or symptoms.Copyright © 2020 Elsevier Inc. All rights reserved.

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