Choroid plexus changes after temporal lobectomy

BACKGROUND AND PURPOSE: Postoperative contrast-enhanced MR imaging of the b rain is routinely used when evaluating for residual or recurrent brain tumo r. It is imperative to be aware of morphologic changes and imaging features that typically occur in response to surgical manipulation at the postopera tive site to avoid misinterpretation of imaging findings. Our purpose was t o determine normal postoperative changes and alterations in the choroid ple xus among patients who had undergone temporal lobectomy in order to disting uish this appearance from pathologic changes that may be seen in the presen ce of infection or recurrent tumors, METHODS: We reviewed 159 MR scans from 95 patients with hippocampal scleros is or gliosis who underwent temporal lobectomy for treatment of intractable epilepsy. Choroid plexus location and size were assessed on contrast-enhan ced T1-weighted images. RESULTS: After temporal lobectomy, the choroid plexus enlarged and sagged i nto the resection site. Increase in the size of the choroid plexus occurred in 58% of cases overall, The degree of enhancement also increased after su rgery, sometimes resulting in a nodular pattern of enhancement. The changes mere most marked during the Ist meek after temporal lobectomy, and showed an enlarged, markedly enhancing choroid plexus on 86% of the scans. CONCLUSION: Postoperative changes of the choroid plexus after temporal lobe ctomy include sagging into the resection site, an increased size, and an in creased degree of enhancement. Normal postoperative morphologic characteris tics may mimic neoplastic enhancement pattern. Familiarity with this appear ance is important to avoid a pitfall in diagnosis of recurrent postoperativ e temporal lobe neoplasms.