Abstract
Transcranial color Doppler guided Matas test permits quantitative noninvasive evaluationof intracranial hemodynamics during temporary occlusion test of the carotid artery . We can determine the indication of reconstructive vascular surgery in patients of head and neck carcinoma with the carotid artery involvement by using transcranial Doppler (TCD) insonation. But sometimes it is very difficult to obtain Doppler signals especially in elderly patients due to attenuation of ultrasound by skull. And that had been a major limitation of the method.From 1991 to 1992, we could not obtain bloodf low signals by ordinary TCD in 4 of all the patients with head and neck carcinoma requiring the carotid artery resection. With informed consent, these 4 patients underwent small cranial fenestration surgery in temporal region under local anesthesia for making a acoustic window of TCD . TCD through bar hole allows us to obtain a clear image of cerebral arterial architecture including circle of willis. And precise and comprehensive evluation of cerebral collateral pattern can be observed. Furthermore, this method seems to be very helpful not only diagnosing the necessity of reconstructive vascular surgery but also monitoring cerebral circulation in the long-term follow up.
