Introduction: Fluorescein sodium (FNa) is a fluorescent substance used to evaluate cerebral blood flow. We present our first cases of vascular microsurgery using microscope-integrated intraoperative fluorescein video angiography. We review the practical applications and benefits of this technique in vascular microsurgery. Clinical cases: A 63-year-old woman, Glasgow: 9 on admission, with subarachnoid hemorrhage (SAH) Fisher IV. A ruptured anterior communicating aneurysm was diagnosed. After stabilization in the ICU, she underwent surgery, undergoing microsurgical clipping guided by intraoperative videoangiography. The postoperative evolution was favorable. A 33-year-old man with a history of epilepsy on carbamazepine treatment. After suspension and irregular treatment 2 years ago, seizures reappear. An angiography and magnetic resonance imaging were performed, and he was diagnosed with a left posterior temporal arteriovenous malformation (AVM) close to Wernicke's area, for which he underwent surgery using tractography and videoangiography in real-time integrated into Neuronavigation. In both cases, the benefits of using the integrated microscope were observed thanks to the vascular anatomical assessment in real-time with fluorescein. Conclusion: Videoangiography with FNa allows examining afferent and efferent vessels during surgery for arteriovenous malformations, checking the persistence of flow in a microvascular anastomosis, and evaluating flow during clipping of an aneurysm. It has the advantages of being able to be repeated during surgery, allowing surrounding anatomical visualization, as well as allowing any surgical correction in real-time. Keywords: Fluorescein Angiography, Microsurgery, Aneurism, Arteriovenous Malformations (Source: MeSH NLM)
Introduction: Complete resection of a cerebral arteriovenous malformation (AVM) eliminates the risk of bleeding1. Although AVMs that adjoin eloquent areas have been studied with functional neuroimaging or intraoperative mapping, 2 the usefulness of tractography has been limited to case reports or small series. Selecting the patient for surgery for an AVM close to an eloquent area is a challenge. 3 Clinical case: 33-year-old man with a clinical picture of epilepsy for 8 years controlled with carbamazepine. Two years ago, after suspension of treatment, the seizures reappeared, some of the auditory hallucinations "voices asking for help." Brain tomography (CT) showed a hyperdense lesion suggestive of AVM in the left temporal region, which was confirmed with magnetic resonance imaging (MRI) and cerebral angiography. The AVM was completely resected using the tractography integrated into the Neuronavigation. Conclusion: Magnetic resonance tractography integrated into the Neuronavigation allows to assess in real-time the proximity of the nidus of AVM to the arcuate fasciculus tract and the use of intraoperative fluorescein video angiography allows to assess vascularity in real-time. All of this makes it possible to perform total resection without causing injury to the eloquent area by avoiding compromising the fibers of the arcuate fasciculus tract. Keywords: Intracranial Arteriovenous Malformations, Neuronavigation, Fluoresceins (Source: MeSH NLM)
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