[Operative neurosurgery: Personal view and historical backgrounds. (10) Microneurosurgery and PET scan: clinical experience of a neurosurgeon].
During the author's clinical activity at three institutes : Kyoto University Hospital (Kyoto 1965-1969, 1977-1985), National Cardiovascular Center NCVC (Osaka 1986-1992) and Zurich University Hospital (Zurich 1970-1976, 1993-2007), He has experienced (underlined periods) working with PET scan and SPECT in relation to microsurgical treatment. The following describes how and for what the author has been engaged in this regard. 1. As preparation for the work with PET, SPECT with a rotating gamma camera was used to know blood distribution with the use of Kr-81m infusion from a selectively located catheter in the ICA, ECA or VA, e.g. to know the flow distribution of a newly constructed EC-IC bypass, which was quite separated from and not mixed up with that of already functioning inherent collaterals (Fig. 1). 2. With the use of inhalation PET scan (15O labelled CO2 and O2 inhalation and 15O CO inhalation) basic knowledge of hemodynamics of MMD was acquired (Fig. 2) 3. With the use of H215 O-PET scan with DiamoxR loading, indication for and effectiveness of EC-IC bypass surgery for occlusive cerebrovascular disease (atherosclerosis (anterior circulation (Fig. 5), posterior circulation (Fig. 6, 7)), MMD (Fig. 9), congenital disease (Fig. 8) have been settled or demonstrated. 4. In epileptic seizures, interictally or intraictally, the active locus has been identified by the use of FDG-PET, flumazenil-PET, H 2 15 O or 13 NH 3-PET respectively (Fig. 12). In this relation, selective Wada test with the use of Tc-99 m-ECD selective infusion together with Amytal R through a catheter inserted selectively into the anterior choroidal artery is an important preoperative test for the SAHE (Fig. 13). 5. FDG-PET and/or tyrosine PET supply important clues concerning appropriate surgical treatment strategy, and also for intractable glioblastoma or high grade glioma, so that in combination with radiotherapy and chemotherapy one may expect more excellent long term outcome with good quality of life (Fig. 16, 17). Furthermore, there must be cases with dementia in which some revascularization procedure might be of help, for which FDG-and H 2 15O-PET could be helpful for differential diagnosis and indication of surgery (Fig. 18).
Yasuhiro
Y
Yonekawa
D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007564:Japan; D008866:Microsurgery / Q000266:history*; D009493:Neurosurgery / Q000266:history*; D049268:Positron-Emission Tomography / Q000266:history*