Assessment of Pre- and Post-Operative Cerebral Perfusion in Anterior Circulation Intracranial Aneurysm Clipping Patients at Hospital Sungai Buloh Using CT Perfusion Scan and Correlations to Fisher, Navarro and WFNS Scores
- Author:
Ailani Ab Ghani
;
Saiful Azli Mat Nayan
;
Azmin KassRosman
- Publication Type:Journal Article
- Keywords:
intracranial aneurysm, cerebral vasospasm, brain ischemia, brain infarction, cerebrovascular
- From:Malaysian Journal of Medical Sciences
2017;24(1):47-58
- CountryMalaysia
- Language:English
-
Abstract:
Background: Intracranial aneurysms may rupture and are typically associated with high
morbidity and mortality, commonly due to vasospasm after rupture. Once the aneurysm ruptures,
the patient’s cerebral blood flow may be disturbed during the acute phase, affecting cerebral
circulation and thus cerebral perfusion prior to the onset of vasospasm. Fisher and Navarro
scores are used to predict vasospasm, while World Federation of Neurosurgical Societies (WFNS)
scores are used to predict patient outcomes. Several score modifications are available to obtain
higher sensitivity and specificity for the prediction of vasospasm development, but these scores
are still unsuccessful. Alternatively, cerebral CT perfusion scan (CTP) is a non-invasive method
for measuring cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time
(MTT) in regions of interests (ROI) to obtain the cerebral perfusion status as well as detecting
vasospasm.
Methods: A total of 30 patients’ data with clipped anterior circulation intracranial
aneurysms admitted to the hospital between 1 January 2013 and 30 June 2014, were collected
from the hospital’s electronic database. The data collected included patients’ admissions
demographic profiles, Fisher, Navarro and WFNS scores; and their immediate pre- and postoperative
CTP parameters.
Results: This study found a significant increase in post-operative MTT (pre- and postoperative
MTT) were 9.75 (SD = 1.31) and 10.44 (SD = 1.56) respectively, (P < 0.001)) as well as a
significant reduction in post-operative CBF (pre- and post-operative mean CBF were 195.29 (SD =
24.92) and 179.49 (SD = 31.17) respectively (P < 0.001)). There were no significant differences in
CBV. There were no significant correlations between the pre- and post-operative CTP parameters
and Fisher, Navarro or WFNS scores.
Conclusion: Despite the interest in using Fisher, Navarro and WFNS scores to predict
vasospasm and patient outcomes for ruptured intracranial aneurysms, this study found no
significant correlations between these scores in either pre- or post-operative CTP parameters. These results explain the disagreement in the field regarding the multiple proposed grading
systems for vasospasm prediction. CTP measures more than just anatomical structures; therefore,
it is more sensitive towards minor changes in cerebral perfusion that would not be detected by
WFNS, Fisher or Navarro scores.
- Full text:P020170313565471326275.pdf
