gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

The role of CT-angiography for identification of intracranial circulatory arrest in brain death

Meeting Abstract

  • S. Welschehold - Neurochirurgische Klinik, Johannes-Gutenberg-Universität Mainz
  • S. Boor - Institut für Neuroradiologie, Johannes-Gutenberg-Universität Mainz
  • K. Riedel - Neurochirurgische Klinik, Johannes-Gutenberg-Universität Mainz
  • T. Kerz - Neurochirurgische Klinik, Johannes-Gutenberg-Universität Mainz
  • A. Reuland - Neurochirurgische Klinik, Johannes-Gutenberg-Universität Mainz
  • P. Stoeter - Institut für Neuroradiologie, Johannes-Gutenberg-Universität Mainz

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.03-04

DOI: 10.3205/09dgnc013, URN: urn:nbn:de:0183-09dgnc0138

Published: May 20, 2009

© 2009 Welschehold et al.
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Outline

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Objective: Several technical procedures are used as exclusive methods in brain death diagnosis to prove irreversibility or as obligatory complements in the diagnosis in primarily infratentorial pathologies. Due to widespread availability of multislice CT-scanners intracranial vascular imaging and brain-perfusion studies are getting more popular. The technique seems to be useful as an additional procedure in the determination of brain death. Compared to established procedures in the diagnosis of cerebral circulatory arrest CT-angiography appears to be superior due to high spatiotemporal resolution. The available published data provide no definite conclusion.

Methods: Prospective study. After clinical examination of brain stem areflexia and apnoea CT-angiography was performed with a special protocol (Scan C6-Vertex, arterial and venous phase). Results of CT-angiography are compared to transcranial Doppler, evoked potentials, and EEG.

Results: 12 patients were included in the study (11 primary, 1 secondary brain injury, age between 18–79 years, mean 54 years). In 10 out of 12 cases the results with CT-A were consistent with electrophysiological (SEP, EEG) examinations and Doppler. In one case the initial CT-A demonstrated a residual flow in ACA, MCA, PCA and BA. This result was confirmed with TCD and SEP. A second examination after additional 12 hours demonstrated cerebral circulatory arrest with both methods (CT-A, Doppler). In the second case CT-A demonstrated a massive reduction of cerebral perfusion, correlated with pendular flow in Doppler. Neither in SEP and AEP, nor in EEG cerebral electrical activity could be detected.

Conclusions: Preliminary results suggest that the presented CT-A-protocol is an appropriate procedure to establish the diagnosis of brain death with high sensitivity and specificity. We would like to call the attention to further evaluation, e.g. a multicenter study for this method.