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Background and Purpose: The purpose of this study was to demonstrate scintigraphic evaluation of cerebral perfusion in patients with intracranial hemangiomas., Material and Method: The examination was carried out in 12 patients aged from 12 to 67 years. In all the patients cerebral angiomas were previously diagnosed and all of them were qualified for intravascular embolization. Brain scintigraphy was performed after IV injection of 99mTcECD and included the dynamic phase with images obtained every 2 seconds for 1.5 minutes and SPECT imaging. The semiquantitative analysis of regional cerebral blood flow was based on the comparison between activity in two symmetrical regions of interest. Cerebral angiography combined with intravascular embolization followed the scintigraphic examination., Results: Based on angiograms, the size of the nidus was estimated at 1.0 to 9.0 cm. In 8 patients the dynamic study showed an increased tracer accumulation in the region of angioma. On SPECT images the nidus was visualized as focally decreased perfusion in all cases. A decreased tracer accumulation in the area adjacent to the nidus was detected in 8 patients. The ratio of activity in the region of angioma to activity in normally perfused tissue calculated using the semiquantitative analysis was 52% to 89%., Conclusions: SPECT images and dynamic phase of cerebral perfusion scintigraphy allow perfusion changes caused by the presence of intracranial angiomas to be identified.

Background: Arteriovenous malformations (AVM) markedly alter the distribution of the regional cerebral blood flow, as they consist of abnormal arteries and veins with no resistance vessels between them. The aim of this study was to the evaluate diagnostic utility of cerebral perfusion scintigraphy (dynamic phase and SPECT) in patients with AVM., Material and Methods: Nineteen patients were examined. All the patients had been previously diagnosed with AVM and qualified for intravascular embolization. Brain scintigraphy was performed with 99mTc-ECD and included dynamic phase and SPECT imaging. The regional blood flow was evaluated visually and semi quantitatively, based on comparison between the activity in the two symmetrical regions of interest. Differences higher than 10% were considered significant. Cerebral angiography combined with intravascular embolization was carried out after a scitigraphic examination., Results: Based on angiograms, the diameter of the AVM nidus was estimated and varied from 1.0 cm to 9.0 cm. In 13 cases, AVM were visible in the dynamic scintigraphy as areas of increased tracer activity. In each case, SPECT images showed the AVM nidus as a region of decreased tracer accumulation. Hypoperfusion in the brain tissue adjacent to the nidus was seen in 15 subjects. In one patient cerebellar diaschisis was present. The average ratio of activity in the region of AVM to activity in the normally perfused tissue calculated by semiquantitative analysis was 77.5 +/- 10.9%., Conclusion: Cerebral perfusion scintigraphy (SPECT images and dynamic scintigraphy) allows one to identify perfusion disturbances caused by the presence of intracranial AVM.

Surgical clipping has been considered for years a "golden standard" in the treatment of middle cerebral artery (MCA) aneurysms. The recent development of materials and endovascular techniques has permitted the use of embolization for the treatment of intracranial aneurysms regardless of their locations and size. In 30 patients with 32 MCA aneurysms (group I) the endovascular approach with GDC-10 coils was used, while in other 30 patients with 31 aneurysms (group II) surgical clipping was performed. On completion of the diagnostic process the patients were randomly assigned either to the endovascular or microsurgical treatment. Group I: 21 (70%) embolization procedures were carried out, while in 9 (30%) cases with 10 aneurysms embolisation was impossible or regarded as too risky due to various causes. The total occlusion of aneurysm SAC was achieved in 17 (77%) aneurysms, subtotal in 5 (23%). The morbidity rate was 8%, mortality-0%. Group II: Microsurgical clipping was performed in 27 (90%) cases, 3 (10%) patients were disqualified from treatment due to their poor clinical status. An excellent technical result was achieved in 24 (86%) patients, in 4 (14%) cases the neck remnant was observed in control angiography. The morbidity rate was 14%, mortality-0%.

A giant, unclippable right ICA aneurysm located partially intracavernously is reported with neck deriving at C3 level. The aneurysm caused optic chiasm compression, progressive left eye vision loss and exophthalmus as well as persistent headache. The presence of the aneurysm was first found in CT and confirmed by angiography. After having performed the temporary occlusion test of right ICA the ICA was permanently occluded with a detachable balloon. Control angiography showed complete occlusion of right ICA and no opacification of the aneurysm sac from vertebral and left carotid arteries.