Significance of postoperative crossed cerebellar hypoperfusion in patients with cerebral hyperperfusion following carotid endarterectomy: SPECT study
Significance of postoperative crossed cerebellar hypoperfusion in patients with cerebral hyperperfusion following carotid endarterectomy: SPECT study
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DOI：
10.1007/s00259-007-0588-x
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发表时间：
2008-01-01
影响因子：
9.1
通讯作者：
Ogawa, Akira
中科院分区：
文献类型：
--
作者：
Ogasawara, Kuniaki;Kobayashi, Masakazu;Ogawa, Akira
目的颈动脉内膜切除术（CEA）后脑过度灌注可导致脑过度灌注综合征和认知功能障碍。本研究的目的是通过单光子发射计算机断层扫描（SPECT）评估脑灌注，阐明CEA术后脑灌注过度患者的交叉小脑低灌注（CCH）的临床意义。对80例同侧颈内动脉狭窄（≥ 70%）患者术前、术后即刻及术后第3天进行放射自显影。根据CEA前后双侧小脑半球灌注不对称性的差异确定术后CCH。术前和术后第一个月进行神经心理学测试。结果11例患者在CEA后立即进行SPECT成像时出现脑过度灌注（脑血流量增加>= 100%，与术前值相比）。其中7例患者在术后第3天观察到CCH。所有三名高灌注综合征患者在术后第三天均表现出脑高灌注和CCH，并出现术后认知功能障碍。在8例无症状性高灌注患者中，4例显示CCH，尽管术后第3天脑高灌注消退，其中3例患者出现术后认知功能障碍。相比之下，4例术后没有CCH的患者没有经历术后认知功能障碍。结论术后CCH伴随脑过度灌注的存在反映了过度灌注综合征的发展。此外，CEA术后脑灌注过度患者术后CCH的存在提示术后认知功能障碍的发展，即使无症状。
Purpose Cerebral hyperperfusion after carotid endarterectomy (CEA) results in cerebral hyperperfusion syndrome and cognitive impairment. The goal of the present study was to clarify the clinical significance of postoperative crossed cerebellar hypoperfusion (CCH) in patients with cerebral hyperperfusion after CEA by assessing brain perfusion with single-photon emission computed tomography (SPECT).Methods Brain perfusion was quantitatively measured using SPECT and the [I-123]N-isopropyl-p-iodoamphetamine-autoradiography method before and immediately after CEA and on the third postoperative day in 80 patients with ipsilateral internal carotid artery stenosis (>= 70%). Postoperative CCH was determined by differences between asymmetry of perfusion in bilateral cerebellar hemispheres before and after CEA. Neuropsychological testing was also performed preoperatively and at the first postoperative month.Results Eleven patients developed cerebral hyperperfusion (cerebral blood flow increase of >= 100% compared with preoperative values) on SPECT imaging performed immediately after CEA. In seven of these patients, CCH was observed on the third postoperative day. All three patients with hyperperfusion syndrome exhibited cerebral hyperperfusion and CCH on the third postoperative day and developed postoperative cognitive impairment. Of the eight patients with asymptomatic hyperperfusion, four exhibited CCH despite resolution of cerebral hyperperfusion on the third postoperative day, and three of these patients experienced postoperative cognitive impairment. In contrast, four patients without postoperative CCH did not experience postoperative cognitive impairment.Conclusions The presence of postoperative CCH with concomitant cerebral hyperperfusion reflects the development of hyperperfusion syndrome. Further, the presence of postoperative CCH in patients with cerebral hyperperfusion following CEA suggests development of postoperative cognitive impairment, even when asymptomatic.