Angiography and Cerebral Perfusion Scintigraphy in Balloon Test Occlusion of Carotid Artery in Head and Neck Tumors

Abstract

Purpose: Surgery of head and neck tumors and other tumors involving the carotid artery may demand complete sacrifice of the carotid as part of the necessary tumor therapy. Sacrifice of the carotid may result in permanent brain perfusion damage. This uncorrectable procedure has to be tested beforehand in order to exclude this possibility.

Materials and Methods: In order to predict this possible unstable hemodynamic brain perfusion damage, we evaluated 12 patients with head neck tumors prior to possible sacrifice of the carotid. The following tests were applied: angiography of the neck vessels, balloon test occlusion (BTO) of the carotid lasting 10 minutes combined with perfusion reserve testing using 1000 mg acetazolamide i. v. All patients received brain perfusion scintigraphy SPECT with Tc-99 m HMPAO injected during BTO.

Results: All patient data were evaluated for clinical neurological defects under BTO. Perfusion of the great vessels was evaluated semiquantitatively for angiography (filling delay of the ophthalmic artery) and perfusion SPECT. None of the patients suffered from neurological defects. 9 /12 patients showed mild to severe perfusion defects. 9 /12 patients showed filling delays of more than1 second. Both tests showed a very good correlation (p = 0.005). Only 2 /12 cases were discrepant in one degree. All severe defects were congruent in both tests.

Conclusion: None of the patients with severe defects underwent sacrifice of the carotid. Both tests resulted in increased security regarding the prediction of possible brain perfusion damage. The combination of angiography and brain scintigraphy is logistically easy and has a high value of prediction.

Zusammenfassung

Ziel: Operationen von Kopf-Hals-Tumoren erfordern möglicherweise den kompletten Verschluss der A. carotis. Die Auswirkungen der Opferung der Karotis auf die Hirndurchblutung muss ausreichend vor diesem radikalen Schritt mit möglichen permanenten Hirnschäden überprüft werden.

Material und Methoden: Um diesen eventuellen instabilen hämodynamischen Hirnperfusionsschaden nach dem Verschluss der Karotis vorherzusagen, wurden 12 Patienten mit verschiedenen Kopf-Hals-Tumoren vor einer geplanten Operation einer Ballon-Test-Okklusion (BOT) mit folgenden Tests unterzogen: Angiografie der Halsgefäße, BOT über 10 min, kombiniert mit Evaluation der Hirnperfusionsreserve mit 1000 mg Acetazolamide während der BOT. Alle Patienten erhielten eine Hirnperfusions-Szintigrafie mit Tc-99 m HMPAO.

Ergebnisse: Die Patientendaten wurden bezüglich klinisch neurologischer Symptome unter BOT (und Azetazolamide), Perfusionsdarstellung der großen Gefäße in der Angiografie und der Hirnperfusion im SPECT mittels semiquantitativer Skala ausgewertet. Neurologische Defizite traten bei keinem Patienten auf. 9 /12 Patienten zeigten milde bis größere Perfusionsdefekte, 9 /12 Patienten zeigten mittlere bis größere Füllungsdefekte der A. ophtalmica auf, beide Tests zeigten statistisch eine sehr gute Korrelation (p = 0,005). Lediglich in 2 /12 Fällen zeigten sich Diskrepanzen um eine Stufe. Alle schweren Defekte waren kongruent in beiden Tests.

Schlussfolgerung: Kein Patient mit größeren Defekten wurde operiert. Zwei gleich gute Tests ergaben eine erhöhte Sicherheit bezüglich der Vorhersage von möglichen Hirnperfusionsschäden. Die Kombination von Angiografie und Hirn-Szintigrafie ist logistisch einfach mit einem hohen Aussagewert durchzuführen.

Key words

angiography - SPECT - balloon insertions

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