Cerebral perfusion SPECT studies with internal carotid artery occlusion in base of Skull tumors management - C.I. experience.

Patients with Base of Skull tumors are assessed for radical craniofacial resection procedures. If tumor is found to be infiltrating internal carotid artery then it has to be sacrificed. But in some patients such a sacrifice will lead to neurological deficit afterwards even if the carotid angiogram is showing good circulation. Hence these patients are assessed preoperatively with cerebral perfusion SPECT study with internal carotid artery occlusion. If the occlusion study is grossly abnormal with hypo perfusion then a repeat perfusion study is done without occlusion to find out the basal status. If this study is normal then the internal carotid artery has to be preserved. Initially contra lateral Carotid Angiogram is done with cross compression to find out the adequacy of the collateral circulation of the opposite cerebral hemisphere. In the next stage we occlude the ipsilateral internal carotid artery with balloon and this procedure is continued for 45 minutes. A careful watch is kept for development of any morbidity. After 45 minutes Tc99m ECD is injected I.V. and balloon occlusion released. Cerebral perfusion SPECT study performed. Between Jan. 2000 and July 2005. 20 patients were evaluated for safety of possible permanent internal carotid artey occlusion.