Assessment of Hyperperfusion by Brain Perfusion SPECT in Transient Neurological Deterioration after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis Surgery.
- Author:
Jeong Won LEE
1
;
Yu Kyeong KIM
;
Sang Mi LEE
;
Jae Sun EO
;
Chang Wan OH
;
Won Woo LEE
;
Jin Chul PAENG
;
Sang Eun KIM
Author Information
1. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea. paengjc@paran.com
- Publication Type:Original Article
- Keywords:
STA-MCA anastomosis;
(99m)Tc-ECD SPECT;
transient neurological deterioration
- MeSH:
Acetazolamide;
Brain;
Cerebral Arteries;
Humans;
Middle Cerebral Artery;
Perfusion;
Tomography, Emission-Computed, Single-Photon
- From:Nuclear Medicine and Molecular Imaging
2008;42(4):267-274
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis surgery. Materials and METHODS: A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: 50+/-16 yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using (99m)Tc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. RESULTS: In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of the cerebral perfusion ratio on preoperative and tenth postoperative day between patients with TND and other patients. CONCLUSION: In patients with TND, relative and moderate hyperperfusion was observed in affected side after bypass surgery. These finding may help to understand the pathophysiology of TND.
