Ab. Ghani, Ailani
(2015)
Pre and post-operative cerebral circulation assessment in anterior circulation intracranial aneurysm clipping patients using CT perfusion scan.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction
Intracranial aneurysm is an abnormal dilatation of blood vessel that may rupture causing
intracranial bleed; commonly subarachnoid haemorrhage (SAH). It is associated with high
morbidity and mortality commonly due to vasospasm. Fisher grade and Navarro score are
among the grading used to predict vasospasm while WFNS grading is used to predict its
outcome. Few new modifications of the existing grading are available to obtain a higher
sensitivity and specificity to predict the development of vasospasm but still unsuccessful.
Once an intracranial aneurysm ruptures, patient’s cerebral blood flow may be disturbed
during the acute phase of aneurysm rupture resulting in some effect on the patient’s cerebral
circulation and autoregulation hence their cerebral perfusion even prior to the onset of
vasospasm. This may influence the outcome of these patients. CTP is a method to measure
the cerebral perfusion status and the values can be compared pre and post-operatively.
Objectives
To determine the relationship between cerebral CTP parameters (CBF, CBV and MTT) with
Fisher grade, WFNS grade, Navarro score and modified Rankin score in patients undergoing
intracranial aneurysm clipping at 3 and 6 months post-operatively as well as to compare the
pre and post-operative CTP parameters in all patients, those with and without hypertension
and those with new post-operative infarct.
Methods
This is a retrospective collection of data obtained from the electronic database for patients
undergoing microsurgical clipping of intracranial aneurysm between 1st Jan 2013 to 30th June
2014 in Hospital Sungai Buloh. A total of 30 patients were recruited in this study. Data
collected include the patient’s demographic profile, Fisher, WFNS and Navarro score. Both
pre and post-operative CTP parameters (CBF, CBV and MTT) are collected to obtain the
mean value. The presence of infarcted areas pre and post-operatively are obtained from the
CT brain radiology report based on the CT brain done on the day of admission and postoperative
day 1. Modified Rankin scale is taken during patients’ follow-up visit in clinic at 3
and 6 months.
Results
30 patients are recruited for this retrospective study, majority are males (56.7%) with mean
age of 48.9 years old. 85.7% of patients have hypertension and the commonest location for
intracranial aneurysm is ACOM aneurysm (56.7%). Most of our patients are WFNS I
(33.3%), Fisher grade 3 (50.0%) and Navarro score 6 (20.0%). There is no significant
correlation between the mean CBF, CBV and MTT with WFNS, Fisher and Navarro score.
There is a significant inverse moderate correlation between pre-operative mean MTT and
mRS at 3 months (r=-0.393, p<0.05). Similarly, there was a significant inverse moderate
correlation between pre-operative mean CBV and infarct (r=-0.366, p<0.05), as well as
between pre-operative mean CBF and infarct (r=-0.456, p<0.05). There is a significant
inverse moderate correlation between post-operative mean MTT and mRS at 3 months (r=-
0.401, p<0.05). In contrast, there is a significant moderate correlation between post-operative
mean CBF and mRS at 3 months (r=0.454, p<0.05). Similar significant moderate correlation
was found between post-operative mean CBF and mRS at 6 months (r=0.559, p<0.05).
Comparing between the pre and post-operative mean MTT and mean CBF, all our patients
have increase post-operative mean MTT with combination of reduce post-operative mean
CBF (p<0.001) including those without hypertension. In hypertensive patients, there is only
significant increase in the mean MTT. Similar increase in post-operative mean MTT and
decrease in post-operative CBF is found in both patients with and without new infarct in their
post-operative CT brain.
Conclusion
The conclusion from this study is there is no correlation between CT perfusion parameters
with the Fisher grade, WFNS grade and Navarro score. For mRS at 3 months, there is an
inverse correlation between the pre-operative mean MTT and post-operative mean MTT. A
positive correlation is appreciated between mRS both at 3 months as well at 6 months with
post-operative mean CBF. In general, patients undergoing microsurgical intracranial
aneurysm clipping are bound to have increased MTT and reduced CBF. Interestingly, patients
with no post-operative CT brain infarct also have similar findings of prolonged MTT with
low CBF; indicating the alteration of cerebral perfusion is present even prior surgical
intervention.
Actions (login required)
 |
View Item |
![[img]](http://eprints.usm.my/style/images/fileicons/application_pdf.png)
