Objective: To prospectively determine temporal changes in regional cerebral perfusion in patients with acutely (<72 h) ruptured cerebral aneurysms treated either endovascularly or surgically.
Methods: Cerebral perfusion was measured both before and 1 week after treatment by use of a (99m)Tc-labeled ethyl-cysteine dimer and single-photon emission computed tomographic (SPECT) studies in 46 of 81 consecutive patients included in a prospective randomized study of early treatment of ruptured aneurysms. In addition to visual analysis of the SPECT images, corticocerebellar perfusion ratios were calculated for seven predefined bilateral regions. Late ischemic deficits were evaluated after 12 months by magnetic resonance imaging of the brain.
Results: Acute perfusion deficits were commonly seen before treatment. In the visual comparison between the first and second SPECT studies, the number of new or enlarged deficits (P = 0.006) and deficits that expanded from unilateral to bilateral (P = 0.020) significantly increased in the surgical group but not in the endovascular group. In the second SPECT study, surgical patients had decreased corticocerebellar perfusion ratios in the right frontobasal cortex (P = 0.012) compared with the endovascular patients, and in the ipsilateral frontobasal cortex (P = 0.002) and ipsilateral temporal apex (P = 0.002) compared with the contralateral side of the ruptured aneurysm. The 12-month magnetic resonance imaging of the brain revealed no significant difference in the number of ischemic deficits between the endovascular and surgical groups.
Conclusion: Disturbances in cerebral perfusion both before and after treatment are common. Although no major differences in the findings were detected between patients treated with either clips or coils, progression of perfusion deficits was more common in the surgical group. However, the 12-month magnetic resonance imaging of the brain revealed equal numbers of ischemic deficits in the treatment groups.