Fluorescein angiography (FAG) was performed at 12 operations of 9 patients with Moyamoya disease in order to know the epicerebral microcirculation. As Encephalo-Myo-Synangiosis (EMS) was performed for the purpose of increasing extra- and intra-cranial collateral circulation in all patients, the cortical surface of the frontotemporal lobe was exposed widely. At first 0.05ml/weight kg of 1% fluorescein was injected into the common carotid artery of the side of the brain (CCA method), and then 5m1 of 10% fluorescein was injected into the peripheral vein (IV method).
The intervals from carotid injection to first appearance of the dye in the cortical arteries were various in each gyrus and were delayed in the most part. In 6 hemispheres of 6 patients, the vessels of some cortical surfaces were not visualized even at the last frame, 26.9 seconds after carotid injection. But the dye appeared in all of the exposed areas by IV method. Regional circulation time was also prolonged in the most part and took more than 10 seconds in some areas of 4 hemispheres of 3 patients. Extravasation of the dye from the small arteries was seen in 5 hemispheres of 4 patients.
FAG findings were nearly correlated with findings of conventional cerebral angiography, but were not always correlated with CT findings and cerebral blood flow measured by 133Xe inhalation method.
On the basis of FAG findings, we consider that it is difficult to analyze cerebral blood flow in Moyamoya disease by 133Xe intracarotid injection method and that EMS is more reasonable than STA-MCA anastomosis for the purpose of increasing external and internal collateral circulation.
