[Prognostic evaluation of glycerol-induced cerebral blood flow measurement in asymptomatic unruptured cerebral aneurysm treatment].
OBJECTIVE
To clarify the usefulness of glycerol-induced cerebral blood flow measurement (G-CBF) as a method for prognostic evaluation of an asymptomatic unruptured cerebral aneurysm (AUCA).


METHODS
Fifty-three patients (age: 26-72 years; ratio of males to females, 23: 30; 56 AUCAs) who were found to have an AUCA(s) on brain checkup at our hospital and then received treatment (direct or intravascular surgery) were the subject of our study. The patients underwent the N-type psychofunction test (NPT) and G-CBF. As the control group, G-CBF was also performed on 50 subjects (age: 36-73 years; ratio of males to females, 27; 23), who were found, by brain checkup, to have no intracranial disease. We investigated (1) the occurrence of post-treatment complications (symptoms/psychofunctional disorders) in the treated group, and compared (2) G-CBF between the complication-developing group, the non-complication-developing group, and the control group.


RESULTS
(1) Complications were observed in 9 patients (17%), including convulsions in 2 patients, hemiparalysis in 1, disorientation in 3. Psychofunctional disorders (less than 80 points on the NPT score) were observed in all of the 9 patients developing complications, but could be determined as higher brain dysfunctions only in the 3 patients with disorientation. (2) The mean cerebral blood flow (mCBF) before glycerol administration was 34.17 +/- 4.82 ml/100 g/min in the complication-developing group, 32.41 +/- 7.29 ml/100 g/min in the non-complication-developing group, and 31.98 +/- 5.04 ml/100 g/min in the control group, showing no significant intergroup differences. The mean increased rate of cerebral blood flow (mIR) after glycerol administration was 7.05 +/- 3.96%, 23.63 +/- 5.5%, and 30.64 +/- 13.08%, respectively, showing a significantly lower increase in the complication-developing group (p < 0.01), particularly low in the frontal lobe. Paradoxical flow reactivity was observed in 2 patients, both of whom were in the complication-developing group.


CONCLUSIONS
(1) The complication-developing group showed a significantly lower pre-treatment mIR (less than 10%), particularly low in the frontal lobe, (2) Paradoxical flow reactivity was observed only in the complication-developing group. (3) G-CBF was very useful for prognostic evaluation prior to the treatment of AUCA.
Takeuchi
Totaro
T
Department of Neurosurgery, Higashimatsuyama Municipal Hospital, 2392 Matsuyama, Higashimatsuyama, Saitama 355-0005, Japan.
Iwasaki
Mitsuyoshi
M
Shirata
Kanji
K
Yokota
Kazuo
K
Kojima
Seiichi
S
Yamazaki
Mihoko
M
D000328:Adult; D000368:Aged; D002560:Cerebrovascular Circulation; D005260:Female; D005990:Glycerol; D006801:Humans; D002532:Intracranial Aneurysm / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis
D005990:Glycerol