Epicerebral Angiography by Fluorescein during Craniotomy

Abstract

In previous reports we have described the use of radio-active isotopes and Coomassie Blue dye injected by internal carotid catheter for analysis of the regional blood flow in the epicerebral circulation (the pial arteries and veins and the cortical capillary bed) during craniotomyl. This method allows for the comparison of quantitative radioisotopic blood flow curves directly with the anatomical pattern of the normal and abnormal vasculature on the surgically exposed brain. This approach has provided information on changes in blood flow in angiomas and adjacent cortex before and after obliteration of arterial feeders, or after arterial manipulation during clipping of aneurysms, and on abnormal flow rates in tumours with arterio–venous shunts. It should be emphasized that this direct comparison of the anatomy and rheology of the cerebral circulation directly from the surface of the brain offers many advantages over the technique of external monitoring by radio-isotopes of cerebral blood flow, where the details of the cerebral microcirculation have not been available. In summary, a new method of fluorescein angiography for demonstration of the epicerebral circulation during craniotomy provides for rapid sequential recording of the flow in the pial and cortical vessels. The advantages of the method include the display of the small vessels of the brain not seen on X-ray angiography so that examination of the cerebral microcirculation in vivo now becomes possible. Secondly, it allows the neurosurgeon to study the anatomical pattern of the epicerebral vessels in man under a wide variety of abnormal conditions.