Severe symptomatic vasospasm: the role of immediate postoperative angioplasty

1994 ◽  
Vol 80 (2) ◽  
pp. 224-229 ◽  
Author(s):  
Peter D. le Roux ◽  
David W. Newell ◽  
Joseph Eskridge ◽  
Marc R. Mayberg ◽  
H. Richard Winn
Keyword(s):  
Clinical Presentation ◽  
Single Photon ◽  
Clinical Success ◽  
Photon Emission ◽  
Transcranial Doppler Ultrasound ◽  
Single Photon Emission ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
Symptomatic Vasospasm

✓ The clinical success of angioplasty for symptomatic vasospasm following subarachnoid hemorrhage (SAH) depends on early intervention and can best be achieved after the aneurysm is occluded. However, patients presenting with unsecured ruptured aneurysms and established clinical vasospasm offer a dilemma for the surgeon. The authors describe the cases of five such patients who underwent acute clipping of aneurysms followed by immediate postoperative angioplasty between 1988 and 1992. All were referred at least 5 days after SAH. Severe vasospasm compatible with the clinical presentation was confirmed by angiography. The patients met the department's criteria for angioplasty but, because of unclipped aneurysms, were first taken to the operating room for a craniotomy and aneurysm obliteration. Angiography was repeated immediately after surgery. Arterial narrowing had progressed during surgery in two patients. In all patients, postoperative mechanical dilatation was achieved with the use of a silicone microballoon. Following angioplasty, transcranial Doppler ultrasound flow velocities and single-photon emission computerized tomography evaluation indicated improved cerebral perfusion compared to preoperative determinations. Four patients improved clinically and made a good recovery. In this subgroup of patients presenting with proven symptomatic vasospasm and an unclipped but ruptured aneurysm, urgent surgical obliteration of the aneurysm followed by immediate postoperative angioplasty may be a safe and reasonable means to improve outcome.

Diagnostic value of 201Tl—single-photon emission computerized tomography studies in cases of posterior fossa hemangioblastomas

2001 ◽  
Vol 95 (2) ◽  
pp. 292-297 ◽  
Author(s):  
Takeo Kondo ◽  
Toshihiro Kumabe ◽  
Shin Maruoka ◽  
Takashi Yoshimoto
Keyword(s):  
Computerized Tomography ◽  
Posterior Fossa ◽  
Single Photon ◽  
Photon Emission ◽  
Magnetic Resonance Images ◽  
Thallium 201 ◽  
Homologous Region ◽  
Single Photon Emission ◽  
Content Type ◽  
Fine Print

Object. The 201Tl uptake index was evaluated for its usefulness in formulating a diagnosis of hemangioblastoma. Thallium-201—single-photon emission computerized tomography (SPECT) studies were performed in nine patients harboring hemangioblastomas in the posterior fossa and in five patients (six lesions) with gliomas in the posterior fossa. Methods. The 201Tl uptake index was defined as the ratio of mean counts of isotope per pixel in the tumor to mean counts of isotope per pixel in the homologous region of the healthy brain. The 201Tl uptake indices of the early image (TlE) and that of the delayed image (TlD) were calculated. The isotope retention index (RI) was calculated as (TlE − TlD)/TlE. The TlE was 2.7 ± 0.7 in hemangioblastomas and 2.9 ± 1.7 in gliomas (mean ± standard deviation). The TlD was 1.5 ± 0.4 in hemangioblastomas and 2.4 ± 1.6 in gliomas. There were no significant differences between hemangioblastomas and gliomas when TlEs and TlDs were compared. The isotope RI was 0.43 ± 0.07 in hemangioblastomas and 0.15 ± 0.1 in gliomas, showing a significantly higher RI in hemangioblastomas compared with gliomas (p < 0.01). Conclusions. Thallium-201 washout is significantly faster in hemangioblastomas. Hemangioblastoma is biologically benign, but contains a rich capillary network that forms a hypervascular tumor bed. Variations in its appearance on magnetic resonance images may cause difficulties in the differential diagnosis of hemangioblastoma. Thallium-201 SPECT studies can be used to distinguish hemangioblastomas from gliomas in the posterior fossa.

scholarly journals Assessing Response UsingTc99m-MIBI Early after Interstitial Chemotherapy with Carmustine-Loaded Polymers in Glioblastoma Multiforme: Preliminary Results

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
D. Cecchin ◽  
I. Schiorlin ◽  
A. Della Puppa ◽  
G. Lombardi ◽  
P. Zucchetta ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Single Photon ◽  
Statistical Significance ◽  
Photon Emission ◽  
Single Photon Emission ◽  
Volume Of Interest ◽  
Effect Of Treatment ◽  
The Difference ◽  
Photon Emission Tomography

Introduction. Early signs of response after applying wafers of carmustine-loaded polymers (gliadel) are difficult to assess with imaging because of time-related imaging changes.Tc99m-sestamibi (MIBI) brain single-photon emission tomography (SPET) has reportedly been used to reveal areas of cellularity distinguishing recurrent neoplasm from radionecrosis. Our aim was to explore the role of MIBI SPET in assessing response soon after gliadel application in glioblastoma multiforme (GBM).Methods. We retrospectively reviewed the charts on 28 consecutive patients with a radiological diagnosis of GBM who underwent MIBI SPET/CT before surgery (with intracavitary gliadel placement in 17 patients), soon after surgery, and at 4 months. The area of uptake was selected using a volume of interest that was then mirrored contralaterally to obtain a semiquantitative ratio.Results. After adjusting for ratio at the baseline, the effect of treatment (gliadel versus non-gliadel) was not statistically significant. Soon after surgery, however, 100% of patients treated with gliadel had a decreased ratio, as opposed to 62.5% of patients in the non-gliadel groupP=0.0316. The difference between ratios of patients with radical versus partial resection reached statistical significance by a small marginP=0.0528.Conclusions. These data seem to suggest that the MIBI ratio could be a valuable tool for monitoring the effect of gliadel early after surgery.

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