Reversal of severe SPECT asymmetry after venous extra-intracranial high flow bypass in a patient submitted to therapeutic internal carotid occlusion: case report

Marcondes, Jorge; Aversa, Antônio; Peçanha, Marcio; Domingues, Flavio S.; Nascimento, Fernanda Amorim de Morais; André, Charles; Freitas, Gabriel R. de; Azevedo, Feliciano; Expósito, María Rosa Alhambra

doi:10.1590/s0004-282x2001000500027

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“…In our institution we have been using the radioisotope technetium-99m ECD for brain SPECT that is pharmacologically similar and less expensive than technetium-99m HMPAOt 24 . Prophylactic bypass procedures have been reserved to the high risk patients who do not tolerate the temporary occlusion or showed a consistent asymmetry on the CBF in the SPECT study 20,25 .…”

Section: Discussionmentioning

confidence: 99%

Complex paraclinoidal and giant cavernous aneurysms: importance of preoperative evaluation with temporary balloon occlusion test and SPECT

Souto

Domingues

Espinosa

et al. 2006

Arq. Neuro-Psiquiatr.

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-In the treatment of complex paraclinoidal and giant cavernous aneurysms, preservation of the patency of the internal carotid artery (ICA) is not always possible, and therapeutic occlusion of the carotid is still an important option for their management. A complete preoperative evaluation of the carotid reserve circulation, including the use of temporary balloon occlusion test and single photon emission computerized tomography (SPECT) should be included in the current paradigms of paraclinoidal and intracavernous aneurysms management. We present a series of fifteen patients with sixteen giant or complex carotid cavernous or ophthalmic aneurysms that were treated following a protocol for our preoperative decision-making analysis. Extracranial to intracranial saphenous vein bypass was reserved to the cases where carotid occlusion would be associated with high risk of ischemic complications and was performed in three patients. Besides the difficulties in dealing with those complex aneurysms, good clinical outcome was possible in our experience with the designed paradigm.KEY WORDS: intracranial aneurysm, cavernous aneurysm, SPECT, balloon occlusion.Aneurismas paraclinoideos complexos e cavernosos gigantes: importância da avaliação pré-operatória com teste de oclusão temporária com balão e SPECT RESUMO -No tratamento de aneurismas paraclinoideos complexos e cavernosos gigantes, a preservação da patência vascular nem sempre é possível, e a oclusão terapêutica da carótida ainda é uma opção importante no seu manejo. Uma avaliação pré-operatória completa da reserva circulatória carotídea, incluindo o uso do teste de oclusão temporária por balão associado à tomografia computadorizada por emissão de fóton único (SPECT) podem ser de grande utilidade para definir a opção terapêutica a ser adotada. Nós apresentamos uma série de quinze pacientes com dezesseis aneurismas complexos ou gigantes do segmento oftálmico e cavernoso da artéria carótida, que foram tratados de acordo com determinado protocolo de investigação pré-operatória. Anastomose com enxerto de veia safena entre a carótida extra e intracraniana foi reservada para os casos em que a oclusão carotídea estaria associada a um alto risco de complicações isquêmicas e foi realizado em três pacientes. Apesar das dificuldades em lidar com aneurismas complexos como os aqui relatados, é possível obter um bom resultado clínico nestes pacientes com o paradigma desenhado.PALAVRAS-CHAVE: aneurisma intracraniano, aneurisma cavernoso, SPECT, oclusão com balão.Advances in surgical techniques and cranial base approaches have greatly improved surgical outcomes with paraclinoidal aneurysms. However, they still represent a challenge for surgical management. A significant number of paraclinoidal aneurysms present as giant and complex aneurysms. Although most of them are manageable by direct clipping, occasionally proximal and distal temporary occlusion and defla-

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Section: Discussionmentioning

confidence: 99%