gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Early CT perfusion used to quantify acute haemodynamic changes after EC/IC bypass surgery in patients suffering from severe cerebrovascular insufficiency

Meeting Abstract

  • Jason Perrin - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Germany
  • Mohamed Elsherbini - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Germany
  • Katharina Hackenberg - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Germany
  • Nima Etminan - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Germany
  • Daniel Hänggi - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMO.05.05

doi: 10.3205/16dgnc026, urn:nbn:de:0183-16dgnc0262

Published: June 8, 2016

© 2016 Perrin et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: EC/IC bypass is the preferred treatment for patients with critical cerebrovascular insufficiency due progressive steno-occlusive disease. Perioperative haemodynamic management is crucial in order to avoid acute complications such as ischemic stroke or hyperperfusion syndrome. The following study was conducted to quantify haemodynamic changes after EC/IC bypass surgery with preoperative and early postoperative CT perfusion (CTP) studies.

Method: Pre- and early postoperative cerebral CTP studies consisting of the relative cerebral blood flow (rCBF) and the relative mean transit time (rMTT) in 3 defined regions of interest (ROI’S) – MCA territory, Anterior border zone and Posterior border zone – were acquired in 40 patients, 2 patients underwent bilateral bypass surgery so that there are 42 hemispheres. rMTT and rCBF for the above mentioned ROI’s were analysed in both ipsilateral and contralateral hemispheres. Interhemispheric comparative studies for bilaterally treated patients were only performed after the first operative procedure. After the second surgery we performed only an intra-hemispheric comparison of the data. Results were then evaluated with the Wilcoxon matched paired test.

Results: Standard STA-MCA bypass was performed on 37 hemispheres, another 4 received high flow bypass and one patient underwent a double barrel STA-MCA bypass. Timing of CTP ranged from 0 day (same day of surgery) to 10 days postoperatively, mean timing being 1.05 days, 29 (66%) of the operated hemispheres underwent CTP on the same day of surgery. Ipsilateral rCBF in the ROI's was increased by 39.8%, from 58,88 ml/100g/min to 79.85 ml/100g/min on the average (P < 0.0001). Mean rMTT did not show a significant decline, measuring 4.8 seconds in preoperative studies compared to 4.4. seconds postoperatively (9%). An increased rCBF was also detected in the contralateral non operated hemispheres (26.9%).

Conclusions: Comparative analysis of pre- and early postoperative CTP studies can be used to quantify haemodynamic changes and therefore aid in optimizing perioperative haemodynamic management in order to prevent acute complications after EC/IC bypass surgery.