Abstract
We evaluated the usefulness of fluorescence cerebral angiography using fluorescein sodium (fluorescein-FCAG) for detecting the blood flow in the cerebral artery and vein during neurological surgery.
The study population comprised 81 patients who underwent aneurysm clipping (76 cases), superficial temporal artery-middle cerebral artery anastomosis (4 cases) and occipital artery-posterior inferior cerebellar artery anastomosis (1 case). After aneurysm clipping and/or anastomosis, the target arteries were illuminated using a beam from a pencil-type probe with a blue light-emitting diode at its tip. After a 2.5-5 ml of 10% fluorescein sodium was injected intravenously, fluorescence in the vessels was clearly observed through a microscope and recorded on videotape. The excellent image quality and spatial resolution of fluorescence facilitated intraoperative real-time assessment of the patency of the target arteries. In large arteries such as internal cerebral artery, images by FCAG using indocyanine green (ICG-FCAG) were clearer than those by fluorescein-FCAG. On the other hand, in perforating arteries, fluorescein-FCAG was superior to ICG-FCAG in resolution. The fluorescence by fluorescein-FCAG disappeared faster than that when ICG-FCAG was used.
Fluorescein-FCAG is very promising because it allows confirmation of the intravascular blood flow from outside. Our findings suggest that observation of the blood flow by fluorescein-FCAG can prevent unexpected cerebral infarctions and improve the surgical outcome.
