Stable xenon CT blood flow mapping for evaluation of patients with extracranial-intracranial bypass surgery

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  • 1 Departments of Neurological Surgery, Radiation Health, and Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, and General Electric Medical Systems Operations, General Electric Co., Milwaukee, Wisconsin
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✓ Xenon computerized tomography (Xe CT) blood flow studies were conducted in 25 patients referred for a possible extracranial-intracranial bypass procedure for occlusive vascular disease in one or more extra- or intracranial vessels. These studies were helpful in selecting eight candidates for surgery. The Xe CT studies were performed at one or two brain levels using a prototype Xe CT system for measurement of cerebral blood flow which was designed in collaboration with the General Electric Co., and adapted for the GE 9800 scanner. In those patients selected to undergo operation, Xe CT demonstrated compromise of flow reserve regionally, globally, and/or in the watershed area. All eight patients who underwent the procedure showed a favorable clinical response postoperatively, and seven had a dramatic increase in flow. The 17 patients whose baseline CT studies showed no reduction of flow with the Xe CT method were not selected for surgery. All 25 patients have remained neurologically stable to date. Case studies of three of the eight patients undergoing bypass surgery are presented.

This limited but consistent experience suggests that Xe CT blood flow mapping makes possible the recognition of brain regions in which flow reserves are compromised. This is due to the relatively high degree of spatial resolution that this technique provides and to the fact that mapping can be correlated directly with the anatomy. Used in combination with a careful clinical examination and an accurate medical history, this study method appears to be a useful guide in the selection of patients who are most at risk from hemodynamic instability and those who are most likely to benefit from flow-augmentation surgery.

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  • 1.

    Ausman JI, , Lee MC, & Chater N, et al: Superficial temporal artery to superior cerebellar artery anastomosis for distal basilar artery stenosis. Surg Neurol 12:277282, 1979 Ausman JI, Lee MC, Chater N, et al: Superficial temporal artery to superior cerebellar artery anastomosis for distal basilar artery stenosis. Surg Neurol 12:277–282, 1979

    • Search Google Scholar
    • Export Citation
  • 2.

    Austin G, , Hayward W, & Laffin D: Modification of cerebral ischemia by microsurgical intracranial anastomosis, in Austin GM (ed): Microneurosurgical Anastomoses for Cerebral Ischemia. Springfield, Ill: Charles C Thomas, 1976, pp 281294 Austin G, Hayward W, Laffin D: Modification of cerebral ischemia by microsurgical intracranial anastomosis, in Austin GM (ed): Microneurosurgical Anastomoses for Cerebral Ischemia. Springfield, Ill: Charles C Thomas, 1976, pp 281–294

    • Search Google Scholar
    • Export Citation
  • 3.

    Austin G, , Laffin D, & Hayward W: Physiologic factors in the selection of patients for superficial temporal artery-to-middle cerebral artery anastomosis. Surgery 75:861868, 1974 Austin G, Laffin D, Hayward W: Physiologic factors in the selection of patients for superficial temporal artery-to-middle cerebral artery anastomosis. Surgery 75:861–868, 1974

    • Search Google Scholar
    • Export Citation
  • 4.

    Axel L: Cerebral blood flow determination by rapid-sequence computed tomography. A theoretical analysis. Radiology 137:679686, 1980 Axel L: Cerebral blood flow determination by rapid-sequence computed tomography. A theoretical analysis. Radiology 137:679–686, 1980

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Baron JC, , Bousser MG, & Rey A, et al: Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography. Stroke 12:454459, 1981 Baron JC, Bousser MG, Rey A, et al: Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography. Stroke 12:454–459, 1981

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Chater N: Patient selection and results of extra to intracranial anastomosis in selected cases of cerebrovascular disease. Clin Neurosurg 23:287309, 1976 Chater N: Patient selection and results of extra to intracranial anastomosis in selected cases of cerebrovascular disease. Clin Neurosurg 23:287–309, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Chater N, , Spetzler R, & Mani J: The spectrum of cerebrovascular occlusive disease suitable for microvascular bypass surgery. Angiology 26:235251, 1975 Chater N, Spetzler R, Mani J: The spectrum of cerebrovascular occlusive disease suitable for microvascular bypass surgery. Angiology 26:235–251, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Damasio H: A computed tomographic guide to the identification of cerebral vascular territories. Arch Neurol 40:138142, 1983 Damasio H: A computed tomographic guide to the identification of cerebral vascular territories. Arch Neurol 40:138–142, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Davis DO, & Pressman BD: Angiography of cerebrovascular disease. Clin Neurosurg 22:163184, 1975 Davis DO, Pressman BD: Angiography of cerebrovascular disease. Clin Neurosurg 22:163–184, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Dhawan V, , Haughton VM, & Thaler HT, et al: Accuracy of stable xenon/CT measurements of regional cerebral blood flow: effect of extrapolated estimates of brain-blood partition coefficients. J Comput Assist Tomogr 8:208212, 1984 Dhawan V, Haughton VM, Thaler HT, et al: Accuracy of stable xenon/CT measurements of regional cerebral blood flow: effect of extrapolated estimates of brain-blood partition coefficients. J Comput Assist Tomogr 8:208–212, 1984

    • Search Google Scholar
    • Export Citation
  • 11.

    Drayer BP, , Wolfson SK Jr, & Reinmuth OM, et al: Xenon enhanced CT for analysis of cerebral integrity, perfusion, and blood flow. Stroke 9:123130, 1978 Drayer BP, Wolfson SK Jr, Reinmuth OM, et al: Xenon enhanced CT for analysis of cerebral integrity, perfusion, and blood flow. Stroke 9:123–130, 1978

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Fein JM, & Olinger R: Cortical nicotinamide adenine dinucleotide (NADH) kinetics in patients undergoing extracranial-intracranial bypass. Neurosurgery 10:428436, 1982 Fein JM, Olinger R: Cortical nicotinamide adenine dinucleotide (NADH) kinetics in patients undergoing extracranial-intracranial bypass. Neurosurgery 10:428–436, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Gado M, & Marshall J: Clinico-radiological study of collateral circulation after internal carotid and middle cerebral occlusion. J Neurol Neurosurg Psychiatry 34:163170, 1971 Gado M, Marshall J: Clinico-radiological study of collateral circulation after internal carotid and middle cerebral occlusion. J Neurol Neurosurg Psychiatry 34:163–170, 1971

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Gibbs J, , Wise R, & Leenders K, et al: The relationship of regional cerebral blood flow, blood volume, and oxygen metabolism in patients with carotid occlusion: evaluation of perfusion reserve. J Cereb Blood Flow Metab 3 (Suppl 1):S590S591, 1983 Gibbs J, Wise R, Leenders K, et al: The relationship of regional cerebral blood flow, blood volume, and oxygen metabolism in patients with carotid occlusion: evaluation of perfusion reserve. J Cereb Blood Flow Metab 3 (Suppl 1):S590–S591, 1983

    • Search Google Scholar
    • Export Citation
  • 15.

    Grubb RL Jr, , Ratcheson R, & Raichle M, et al: Regional cerebral blood flow and cerebral oxygen utilization in superficial temporal-middle cerebral artery anastomosis patients. Acta Neurol Scand 60 (Suppl 72):502503, 1979 Grubb RL Jr, Ratcheson R, Raichle M, et al: Regional cerebral blood flow and cerebral oxygen utilization in superficial temporal-middle cerebral artery anastomosis patients. Acta Neurol Scand 60 (Suppl 72):502–503, 1979

    • Search Google Scholar
    • Export Citation
  • 16.

    Grubb RL Jr, , Ratcheson RA, & Raichle ME, et al: Regional cerebral blood flow and oxygen utilization in superficial temporal-middle cerebral artery anastomosis patients. An exploratory definition of clinical problems. J Neurosurg 50:733741, 1979 Grubb RL Jr, Ratcheson RA, Raichle ME, et al: Regional cerebral blood flow and oxygen utilization in superficial temporal-middle cerebral artery anastomosis patients. An exploratory definition of clinical problems. J Neurosurg 50:733–741, 1979

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Gur D, , Good WF, & Wolfson SK Jr, et al: In vivo mapping of local cerebral blood flow by xenon-enhanced computed tomography. Science 215:12671268, 1982 Gur D, Good WF, Wolfson SK Jr, et al: In vivo mapping of local cerebral blood flow by xenon-enhanced computed tomography. Science 215:1267–1268, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Gur D, , Wolfson SK Jr, & Yonas H, et al: Progress in cerebrovascular disease: local cerebral blood flow by xenon enhanced CT. Stroke 13:750758, 1982 Gur D, Wolfson SK Jr, Yonas H, et al: Progress in cerebrovascular disease: local cerebral blood flow by xenon enhanced CT. Stroke 13:750–758, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Gur D, , Yonas H, & Herbert D, et al: Xenon enhanced dynamic computed tomography: multilevel cerebral blood flow studies. J Comput Assist Tomogr 5:334340, 1981 Gur D, Yonas H, Herbert D, et al: Xenon enhanced dynamic computed tomography: multilevel cerebral blood flow studies. J Comput Assist Tomogr 5:334–340, 1981

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Halsey JH Jr, , Morawetz RB, & Blauenstein UW: The hemodynamic effect of STA-MCA bypass. Stroke 13:163167, 1982 Halsey JH Jr, Morawetz RB, Blauenstein UW: The hemodynamic effect of STA-MCA bypass. Stroke 13:163–167, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Heilbrun MP, , Reichman OH, & Anderson RE, et al: Regional cerebral blood flow studies following superficial temporal-middle cerebral artery anastomosis. J Neurosurg 43:706716, 1975 Heilbrun MP, Reichman OH, Anderson RE, et al: Regional cerebral blood flow studies following superficial temporal-middle cerebral artery anastomosis. J Neurosurg 43:706–716, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Holbach KH, & Wassmann H: Extra-intracranial anastomosis operation associated with hyperbaric oxygenation in the treatment of completed stroke, in Peerless SJ, & McCormick CW (eds): Microsurgery for Cerebral Ischemia. Berlin/Heidelberg/New York: Springer-Verlag, 1980, pp 286291 Holbach KH, Wassmann H: Extra-intracranial anastomosis operation associated with hyperbaric oxygenation in the treatment of completed stroke, in Peerless SJ, McCormick CW (eds): Microsurgery for Cerebral Ischemia. Berlin/Heidelberg/New York: Springer-Verlag, 1980, pp 286–291

    • Search Google Scholar
    • Export Citation
  • 23.

    Jones TH, , Morawetz RB, & Crowell RM, et al: Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 54:773782, 1981 Jones TH, Morawetz RB, Crowell RM, et al: Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 54:773–782, 1981

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Khodadad G: Occipital artery-posterior inferior cerebellar artery anastomosis. Surg Neurol 5:225227, 1976 Khodadad G: Occipital artery-posterior inferior cerebellar artery anastomosis. Surg Neurol 5:225–227, 1976

    • Search Google Scholar
    • Export Citation
  • 25.

    Kishore PR, , Rao GU, & Fernandez RE, et al: Regional cerebral blood flow measurements using stable xenon enhanced computed tomography: a theoretical and experimental evaluation. J Comput Assist Tomogr 8:619630, 1984 Kishore PR, Rao GU, Fernandez RE, et al: Regional cerebral blood flow measurements using stable xenon enhanced computed tomography: a theoretical and experimental evaluation. J Comput Assist Tomogr 8:619–630, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Lebrun-Grandié P, , Baron JC, & Soussaline F, et al: Coupling between regional blood flow and oxygen utilization in the normal human brain. A study with positron tomography and oxygen 15. Arch Neurol 40:230236, 1983 Lebrun-Grandié P, Baron JC, Soussaline F, et al: Coupling between regional blood flow and oxygen utilization in the normal human brain. A study with positron tomography and oxygen 15. Arch Neurol 40:230–236, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Lee MC, , Ausman JI, & Geiger JD, et al: Superficial temporal to middle cerebral artery anastomosis. Clinical outcome in patients with ischemia or infarction in internal carotid artery distribution. Arch Neurol 36:14, 1979 Lee MC, Ausman JI, Geiger JD, et al: Superficial temporal to middle cerebral artery anastomosis. Clinical outcome in patients with ischemia or infarction in internal carotid artery distribution. Arch Neurol 36:1–4, 1979

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Lenzi GL, , Frackowiak RS, & Jones T: Cerebral oxygen metabolism and blood flow in human cerebral ischemic infarction. J Cereb Blood Flow Metab 2:321335, 1982 Lenzi GL, Frackowiak RS, Jones T: Cerebral oxygen metabolism and blood flow in human cerebral ischemic infarction. J Cereb Blood Flow Metab 2:321–335, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    McDowell FH: The extracranial/intracranial bypass study. Stroke 8:545, 1977 (Editorial) McDowell FH: The extracranial/intracranial bypass study. Stroke 8:545, 1977 (Editorial)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Meinig G, , Ulrich P, & Koester E, et al: Followup rCBF after EC/IC anastomoses., in Proceedings of the Sixth International Symposium on Microsurgical Anastomoses for Cerebral Ischemia. (In press, 1985)Meinig G, Ulrich P, Koester E, et al: Followup rCBF after EC/IC anastomoses. Proceedings of the Sixth International Symposium on Microsurgical Anastomoses for Cerebral Ischemia. (In press, 1985)

    • Search Google Scholar
    • Export Citation
  • 31.

    Meyer JS, , Hayman LA, & Sakai F, et al: High resolution three-dimensional measurement of localized cerebral blood flow by CT scanning and stable xenon clearance: effect of cerebral infarction and ischemia. Trans Am Neurol Assoc 104:8589, 1979 Meyer JS, Hayman LA, Sakai F, et al: High resolution three-dimensional measurement of localized cerebral blood flow by CT scanning and stable xenon clearance: effect of cerebral infarction and ischemia. Trans Am Neurol Assoc 104:85–89, 1979

    • Search Google Scholar
    • Export Citation
  • 32.

    Oldendorf WH, & Kitano M: Isotope study of brain blood turnover in vascular disease. Arch Neurol 12:3038, 1965 Oldendorf WH, Kitano M: Isotope study of brain blood turnover in vascular disease. Arch Neurol 12:30–38, 1965

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Reichman OH: Neurosurgical microsurgical anastomosis for cerebral ischemia: five years' experience, in Scheinberg P (ed): Cerebrovascular Diseases. Tenth Princeton Conference. New York: Raven Press, 1976, pp 311330 Reichman OH: Neurosurgical microsurgical anastomosis for cerebral ischemia: five years' experience, in Scheinberg P (ed): Cerebrovascular Diseases. Tenth Princeton Conference. New York: Raven Press, 1976, pp 311–330

    • Search Google Scholar
    • Export Citation
  • 34.

    Sakai F, , Gotoh F, & Ebihara S, et al: Xenon enhanced CT method for the measurement of local cerebral blood flow in man. J Cereb Blood Flow Metab 1 (Suppl 1):S29S30, 1981 Sakai F, Gotoh F, Ebihara S, et al: Xenon enhanced CT method for the measurement of local cerebral blood flow in man. J Cereb Blood Flow Metab 1 (Suppl 1):S29–S30, 1981

    • Search Google Scholar
    • Export Citation
  • 35.

    Samson DS, & Boone S: Extracranial-intracranial (EC-IC) arterial bypass: past performance and current concepts. Neurosurgery 3:7986, 1978 Samson DS, Boone S: Extracranial-intracranial (EC-IC) arterial bypass: past performance and current concepts. Neurosurgery 3:79–86, 1978

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Schmiedek P, , Gratzl O, & Spetzler R, et al: Selection of patients for extra-intracranial bypass surgery based on rCBF measurements. J Neurosurg 44:303312, 1976 Schmiedek P, Gratzl O, Spetzler R, et al: Selection of patients for extra-intracranial bypass surgery based on rCBF measurements. J Neurosurg 44:303–312, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Segawa H, , Wakai S, & Tamura A, et al: CBF study by CT with Xe enhancement — experience in 30 cases. J Cereb Blood Flow Metab 1 (Suppl 1):S52S53, 1981 Segawa H, Wakai S, Tamura A, et al: CBF study by CT with Xe enhancement — experience in 30 cases. J Cereb Blood Flow Metab 1 (Suppl 1):S52–S53, 1981

    • Search Google Scholar
    • Export Citation
  • 38.

    Sundt TM Jr, , Siekert RG, & Piepgras DG, et al: Bypass surgery for vascular disease of the carotid system. Mayo Clin Proc 51:677692, 1976 Sundt TM Jr, Siekert RG, Piepgras DG, et al: Bypass surgery for vascular disease of the carotid system. Mayo Clin Proc 51:677–692, 1976

    • Search Google Scholar
    • Export Citation
  • 39.

    Tamura A, , Graham DI, & McCulloch J, et al: Focal cerebral ischaemia in the rat: 1. description of technique and early neuropathological consequences following middle cerebral artery occlusion. J Cereb Blood Flow Metab 1:5360, 1981 Tamura A, Graham DI, McCulloch J, et al: Focal cerebral ischaemia in the rat: 1. description of technique and early neuropathological consequences following middle cerebral artery occlusion. J Cereb Blood Flow Metab 1:53–60, 1981

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Vorstrup S, , Hemmingsen R, & Henriksen L, et al: Regional cerebral blood flow in patients with transient ischemic attacks studied by xenon-133 inhalation and emission tomography. Stroke 14:903910, 1983 Vorstrup S, Hemmingsen R, Henriksen L, et al: Regional cerebral blood flow in patients with transient ischemic attacks studied by xenon-133 inhalation and emission tomography. Stroke 14:903–910, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Whisnant JP: Extracranial-intracranial arterial bypass. Neurology 28:209210, 1978 Whisnant JP: Extracranial-intracranial arterial bypass. Neurology 28:209–210, 1978

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Yaşargil MG: Experimental small vessel surgery in the dog including patching and grafting of cerebral vessels and the formation of functional and extra-intracranial shunts, in Donaghy RMP, & Yaşargil MG (eds): Micro-Vascular Surgery. St Louis: CV Mosby, 1967, pp 87126 Yaşargil MG: Experimental small vessel surgery in the dog including patching and grafting of cerebral vessels and the formation of functional and extra-intracranial shunts, in Donaghy RMP, Yaşargil MG (eds): Micro-Vascular Surgery. St Louis: CV Mosby, 1967, pp 87–126

    • Search Google Scholar
    • Export Citation
  • 43.

    Yaşargil MG, & Yonekawa Y: Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia. Neurosurgery 1:2224, 1977 Yaşargil MG, Yonekawa Y: Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia. Neurosurgery 1:22–24, 1977

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Yonas H, , Good WF, & Gur D, et al: Mapping cerebral blood flow by xenon-enhanced computed tomography: clinical experience. Radiology 152:435442, 1984 Yonas H, Good WF, Gur D, et al: Mapping cerebral blood flow by xenon-enhanced computed tomography: clinical experience. Radiology 152:435–442, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Yonas H, , Wolfson SK Jr, & Gur D, et al: Clinical experience with the use of xenon-enhanced CT blood flow mapping in cerebral vascular disease. Stroke 15:443450, 1984 Yonas H, Wolfson SK Jr, Gur D, et al: Clinical experience with the use of xenon-enhanced CT blood flow mapping in cerebral vascular disease. Stroke 15:443–450, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Yonekura N, & Austin G: Long-term evaluation of cerebral blood flow in patients with TIA and stroke after STA-MCA anastomosis, in: Proceedings of the Sixth International Symposium on Microsurgical Anastomoses for Cerebral Ischemia. (In press, 1985)Yonekura N, Austin G: Long-term evaluation of cerebral blood flow in patients with TIA and stroke after STA-MCA anastomosis, in: Proceedings of the Sixth International Symposium on Microsurgical Anastomoses for Cerebral Ischemia. (In press, 1985)

    • Search Google Scholar
    • Export Citation

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