Patient Radiation Dose in Diagnostic and Interventional Procedures for Intracranial Aneurysms: Experience at a Single Center

OBJECTIVE: To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms in a large sample size from a single center. MATERIALS AND METHODS: We studied a sample of 439 diagnostic and 149 therapeutic procedures for intracranial aneurysms in 480 patients (331 females, 149 males; median age, 57 years; range, 21-88 years), which were performed in 2012 with a biplane unit. Parameters including fluoroscopic time, dose-area product (DAP), and total angiographic image frames were obtained and analyzed. RESULTS: Mean fluoroscopic time, total mean DAP, and total image frames were 12.6 minutes, 136.6 +/- 44.8 Gy-cm2, and 251 +/- 49 frames for diagnostic procedures, 52.9 minutes, 226.0 +/- 129.2 Gy-cm2, and 241 frames for therapeutic procedures, and 52.2 minutes, 334.5 +/- 184.6 Gy-cm2, and 408 frames for when both procedures were performed during the same session. The third quartiles for diagnostic reference levels (DRLs) were 14.0, 61.1, and 66.1 minutes for fluoroscopy time, 154.2, 272.8, and 393.8 Gy-cm2 for DAP, and 272, 276, and 535 for numbers of image frames in diagnostic, therapeutic, and both procedures in the same session, respectively. The proportions of fluoroscopy in DAP for the procedures were 11.4%, 50.5%, and 36.1%, respectively, for the three groups. The mean DAP for each 3-dimensional rotational angiographic acquisition was 19.2 +/- 3.2 Gy-cm2. On average, rotational angiography was used 1.4 +/- 0.6 times/session (range, 1-4; n = 580). CONCLUSION: Radiation dose in our study as measured by DAP, fluoroscopy time and image frames did not differ significantly from other reported DRL studies for cerebral angiography, and DAP was lower with fewer angiographic image frames for embolization. A national registry of radiation-dose data is a necessary next step to refine the dose reference level.

ICP Trend in Massive ICH Patients After Decompressive Craniectomy / 대한뇌혈관외과학회지

OBJECTIVE: Massive intracerebral hemorrhage (ICH) is devastating neurosurgical disease. Decompression surgery has been performed to manage the uncontrolled increased intracranial pressure and good clinical result has been reported. Authors analyze the ICP trend after the decompression surgery and report the clinical usefulness. METHODS: Thirty patients data with massive ICH were analyzed retrospectively. Surgical indication was constantly followed in these patient ; Glasgowcoma scale score less than 8, midline shift more than 6 mm on brain CT. In all patients ventricular puncture was done before the decompression and monitored the ventricular pressure changes during and after the surgery. RESULTS: In massive ICH patients, the ICP was maintained in physiological range if the hematoma was removed more than 80%. And when we tried additional therapies like hypothermia or coma therapies in another group, the ICP was elevated at the time of the additional therapy. CONCLUSION: From this study, if the ICH removed more than 80% and The ICP was not exceed 20 mmHg during the first post-operation day, the ICP hardly exceed 20 mmHg after than. Authors thought that decompression surgery is not an essential treatment for the massive ICH patient if their hematoma removed enough.

Changes of flow pattern after extracranial intracranial arterial bypass in patients with artherosclerotic cerebral ischemia and moyamoya disease / 대한뇌혈관외과학회지

OBJECTIVE: Extracranial-intracranial arterial bypass (EIAB) has proved to be useful in selected patients with artherosclerotic cerebral ischemia and moyamoya disease. But neurological deterioration (ND) after EIAB has occasionally been reported in spite of successful EIAB. We have performed EIAB in 150 patients with artherosclerotic cerebral ischemia and moyamoya disease during the recent 8 years. We analyzed the patients who exhibited ND after successful EIAB was performed for a selected group of patients with artherosclerotic cerebral ischemia and moyamoya disease. METHODS: Among 150 patients, the cause of the hemodynamic ischemia was atherosclerotic in 90 and moyamoya disease in 60. Eighteen patients experienced ND after successful EIAB. There were 14 patients with temporary neurologic deficit and 5 patients had a permanent deficit. We divided these 18 patients into two groups. Group 1 revealed relative hyperperfusion of a chronically hypoperfused area of the brain after successful EIAB. Group 2 showed hypoperfusion of the brain by the change of the flow pattern after successful EIAB. RESULTS: Of the 18 patients who experienced ND after successful EIAB, 8 patients belonged to group 1 and 10 patients belonged to group 2. We divided group II into four subgroups according to angiographic flow patterns. The first subgroup (2 patients) showed delayed filling of one division out of two divisions of the middle cerebral artery. The second subgroup (3 patients) showed collision between the orthograde flow and the retrograde flow from the grafted vessel, which resulted in more profound hypoperfusion. The third subgroup (2 patients) exhibited a complete occlusion of the preoperative stenotic artery. The fourth subgroup (3 patients) included the cases with marginal hypoperfusion in the periphery of the perfused region from the grafted extracranial artery. CONCLUSION: EIAB is a reliable, reasonably safe method for establishing new pathways of collateral circulation to the brain. However, this operation can have potential complications according to the relative hyperperfusion or hypoperfusion that's due to the altered flow pattern after the bypass.