Long-Term Outcomes of Cerebral Blood Flow and Neurotransmitter Receptor Function on Iodine-123-Iomazenil Single-Photon Emission Computed Tomography and Cognitive Assessments After Parent Artery Occlusion Combined with Cerebral Revascularization for Internal Carotid Artery Aneurysms.

Abstract

OBJECTIVE:

Many studies of external-internal carotid artery (EC-IC) bypass as cerebral revascularization for unclippable internal carotid artery (ICA) aneurysms have reported surgical outcomes, including bypass patency and aneurysm resolution. However, no previous studies have assessed the long-term outcomes of cerebral blood flow (CBF), brain neural density, and cognition. The purpose of the present study was to evaluate the long-term outcomes of CBF and neurotransmitter receptor function using early and late images of iodine-123 (123I)-iomazenil (IMZ) single-photon emission computed tomography (SPECT) and the cognitive function of patients who had undergone EC-IC bypass for symptomatic aneurysms in the cavernous portion of the ICA.

METHODS:

We performed a prospective observational study of 11 patients who had undergone superficial temporal artery-middle cerebral artery bypass or bypass using a saphenous vein graft for symptomatic aneurysms in the cavernous portion of the ICA. One patient experienced extensive infarction and, therefore, did not undergo postoperative testing. 123I-IMZ SPECT was performed with scanning at 23 minutes (early) and 180 minutes (late) after tracer administration before and after surgery. The preoperative and follow-up neuropsychological test scores from 6 patients were also analyzed.

RESULTS:

None of 10 patients who had undergone EC-IC bypass showed reductions in CBF and brain neural density. In addition, the neuropsychological test scores had not changed significantly from preoperatively to postoperatively.

CONCLUSION:

Using early and late 123I-IMZ SPECT, the present study has demonstrated that patients undergoing uncomplicated cerebral revascularization for unclippable ICA aneurysms will not experience reductions in CBF or neurotransmitter receptor function, and their cognitive function was not impaired.

• Authors: Yoshitaka Kubo, Takahiro Koji, Toshiyuki Murakami, Kenji Yoshida, Yoshiyasu Matsumoto, Kuniaki Ogasawara
• Journal: World neurosurgery (World Neurosurg) Vol. 143 Pg. e199-e205 (11 2020) ISSN: 1878-8769 [Electronic] United States
• PMID: 32810631 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• Receptors, GABA-A
• Flumazenil
• iomazenil

Topics

• Aged
• Aged, 80 and over
• Brain (blood supply, diagnostic imaging, metabolism)
• Carotid Artery Diseases (surgery)
• Carotid Artery, Internal (surgery)
• Cerebral Revascularization
• Cerebrovascular Circulation (physiology)
• Cognition (physiology)
• Female
• Flumazenil (analogs & derivatives)
• Humans
• Intracranial Aneurysm (surgery)
• Longitudinal Studies
• Middle Aged
• Middle Cerebral Artery (surgery)
• Prospective Studies
• Receptors, GABA-A (metabolism)
• Saphenous Vein (transplantation)
• Temporal Arteries (surgery)
• Tomography, Emission-Computed, Single-Photon
• Treatment Outcome
• Vascular Grafting