Patient Benefit from Cerebrovascular Reserve Capacity Assessment using Brain SPECT and Hypercapnia


Authors: P. Širůček 1;  O. Kraft 1;  T. Hrbáč 2;  V. Kosek 3
Authors‘ workplace: Fakultní nemocnice Ostrava Klinika nukleární medicíny 1;  Fakultní nemocnice Ostrava Neurochirurgická klinika 2;  Fakultní nemocnice Ostrava Oddělení ekonomiky a financí 3
Published in: Cesk Slov Neurol N 2011; 74/107(3): 299-311
Category: Original Paper

Overview

Aim:
To determine whether symptomatic patients after revascularization brain surgery with reduced cerebrovascular reserve capacity (CVRC) established by brain SPECT and hypercapnia improved in terms of clinical findings and to assess any differences in the incidence of recurrence of stroke or TIA in the patient group with pathological CVRC results treated conservatively or surgically.

Material and Methods:
CVRC using brain SPECT with hypercapnia test was performed in 64 patients. Patients were divided into 3 groups. The first consisted of 31 patients with normal CVRC, the second of 14 patients with pathological CVRC who were treated conservatively, and the third of 19 patients with pathological CVRC who underwent surgical revascularization of the brain.

Results:
Neurological findings improved in 8 of the 19 patients (42%) in Group 3. Stroke and TIA recurrence after surgery was assessed in terms of secondary prevention. One patient had intracerebral haemorrhage after surgery, another 18 patients had no stroke or TIA after surgery. In the group of non-surgically treated patients there was one patient with ipsilateral stroke, one with ipsilateral TIA, and two patients died of fatal stroke. If we compare disease-free survival (DSF) in the two groups of patients with and without surgery, then a statistically difference emerges at a level of p = 0.15.

Conclusion:
CVRC examination is able to help with the selection of patients with occlusive cerebrovascular disease for neurosurgical bypass surgery.

Key words:
cerebrovascular reserve capacity – brain SPECT – hypercapnia


Sources

1. Engelhardt M, Pfadenhauer K, Zentner J, Grimmer S, Wachenfeld-Wahl C, Heidenreich P et al. Impaired cerebral autoregulations in asymptomatic patients with carotid artery stenosis: comparison of acetazolamide-SPECT and transcranial CO2 dopplersonography. Zentralbl Chir 2004; 129(3): 178–182.

2. Choksi V, Hughes M, Selwa L, Hoeffner E. Transient neurologic deficit after acetazolamid challenge for computed tomography perfusion imaging. J Comput Assist Tomogr 2005; 29(2): 278–280.

3. Imaizumi T, Hayashi K, Saito K, Osawa M, Fukuyama Y. Long term outcomes of pediatric moyamoya disease monitored to adulthood. Pediatr Neurol 1998; 18(4): 321–325.

4. Klijn CJ, Kappelle LJ, Tulleken CA, van Gijn J. Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors. Stroke 1997; 28(10):1857–1860

5. Yamada I, Murata Y, Umehara I, Suzuki S, Matsushima Y. SPECT and MRI evaluations of the posterior circulation in moyamoya disease. J Nucl Med 1996; 37(10): 1613–1617.

6. Sameš M, Zolal A, Radovnický T, Vachata P, Bartoš R, Derner M. Použití metod magnetické rezonance pro posouzení cerebrovaskulární rezervní kapacity, Cesk Slov Neurol N 2009; 72/105(4): 323–330.

7. Beneš V. Ischémie mozku: chirurgická a endovaskulární terapie. 1st ed. Praha: Galén 2003.

8. Sameš M. Neurochirurgie: učebnice pro lékařské fakulty a postgraduální studium příbuzných oborů. Praha: Maxdorf 2005.

9. Kuroda S, Kamivama H, Abe H, Houkin K, Isobe M,Misumori K. Acetazolamide test in detecting reduced cerebral perfusion reserve and predicting long--term prognosis in patients with internal carotid artery occlusion. Neurosurgery 1993; 32(6): 912–918.

10. Mohapl M, Svobodová J, Beneš V. Vyšetřování cerebrovaskulární rezervní kapacity. Cesk Slov Neurol N 2004; 67/100(1): 12–15.

11. Ringelstein EB, Van Eyck S, Mertens I. Evaluation of cerebral vasomotor reactivity by various vasodilating stimuli: comparison of CO2 to acetazolamide. J Cereb Blood Flow Metab 1992; 12 (1): 162–168.

12. Krahulík D, Vaverka M, Hrabálek L, Hezig R, Kocher M, Houdek M. Extra-intrakraniální anastomóza: algoritmus vyšetření, technika operace a soubor pacientů za posledních 5 let. Cesk Slov Neurol N 2008; 71/104 (Suppl): 69.

13. Sameš M, Radovnický T, Zolal A, Nováková M, Derner M, Vachata P et al, Změny na perfuzní počítačové tomografii po konvenčním extra-intrakraniálním bypassu. Cesk Slov Neurol N 2010; 73/106(3): 267–273.

14. Nevšímalová S, Růžička E, Tichý J. Neurologie. 1st ed. Praha: Galén 2002.

15. Kleiser B, Widder B. Course of carotid artery occlusions with impaired cerebrovascular reactivity. Stroke 1992; 23(2): 171–174.

16. Šroubek J, Adamková Š, Kovář M. EC/IC anastomóza a chronická hypoperfuze CNS při okluzi vnitřní krkavice. Cesk Slov Neurol N 2008; 71/104 (Suppl): 68.

17. Kanta M, Náhlovský J, Habalová V, Hobza V, Řehák S,Adamkov J. Naše zkušenosti s nízkoprůtokovými EC-IC anastomózami. Cesk Slov Neurol N 2008; 71/104 (Suppl): 69.

18. Fiedler J, Přibáň V, Chlouba V, Schenk I, Škoda O. Konvenční mozkový bypass v indikaci chronického uzávěru vnitřní karotidy: naše zkušenosti u 57 pacientů. Cesk Slov Neurol N 2008; 71/104 (Suppl): 69–70.

19. Sameš M, Bartoš R, Vachata P, Zolal A, Cihlář F, Derner M et al. Hodnocení cerebrovaskulární rezervní kapacity po EC-IC bypassu pomocí TCD. Cesk Slov Neurol N 2009; 72/105(4): 359–363.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2011 Issue 3

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account