Cerebral arterial blood flow and aneurysm surgery

Part 1: Local arterial flow dynamics

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✓ Cerebral arterial blood flow was monitored in 22 patients undergoing surgery for intracranial saccular aneurysms. An electromagnetic flow probe was used to record the internal carotid artery (ICA) flow in the neck or intracranially in seven patients. The ICA flow ranged between 100 and 175 ml/min (average 144 ml/min). Intracranial flow measurements with specially designed probes were made in 17 patients. The middle cerebral artery (MCA) showed flow values between 75 and 120 ml/min (average 97 ml/min). Flow figures recorded from the proximal anterior cerebral artery (ACA) were lower (average 65 ml/min), and had a wider range from 30 to 110 ml/min.

Test occlusion of the terminal ICA showed a retrograde flow in the proximal ACA to the MCA ranging from 15 to 125 ml/min (average 78 ml/min). This test was used to investigate the collateral potential of the anterior portion of the circle of Willis, which is essential to the decision of whether to undertake trap ligation procedures in this location. Flow monitoring in the parent vessel was also of use in some patients to assess flow conditions after the clipping of the aneurysm neck.

Article Information

Address reprint requests to: Helge Nornes, M.D., Department of Neurosurgery, National Hospital of Norway, Rikshospitalet, Oslo, Norway.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 12. Artist's drawing obtained from angiograms and observations through the microscope. The resemblance to a vertebrobasilar system is obvious. The flow probe is positioned on the single distal anterior cerebral artery. A wrapping procedure with purse-string technique was performed.

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    Case 2. Mean and instantaneous flow in left middle cerebral artery (MCA) showing the effect of two test occlusions of the terminal internal carotid artery (ICA).

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    Case 2. Upper Tracings: Flow in left middle cerebral artery during induced hypotension. Mean ABP about 65 mm Hg. Flow at end of second tracing is supplied by posterior communicating artery. Lower Tracings: Final clipping of internal carotid artery with ABP about 100 mm Hg. Test occlusion and permanent clip application are proximal to the posterior communicating artery.

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    Case 17. Artist's drawing showing the flow probe on the right proximal anterior cerebral artery, and a curved McFadden clip occluding the aneurysm and anterior communicating artery.

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    Case 17. Flow recorded from right proximal anterior cerebral artery (ACA). Upper Tracings: Reversal of flow during temporary occlusion of terminal internal carotid artery. Pulsatile (instant) flow showing instantaneous reversal of flow. Mean flow tracing has a slower response due to time constant of electronical integration. Lower Tracings: Flow before and after the clipping procedure illustrated in Fig. 4.

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    Graph showing flow values obtained in this study. Broken lines connect values recorded at different sites in same individual. The numbers refer to cases (Table 1). “Middle cerebral artery (via anterior circle)” refers to the flow into this artery from the anterior circle at internal carotid artery occlusion.

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    Case 10. Flow recording from the right proximal anterior cerebral artery showing reversal of flow during occlusion of the internal carotid artery proximal to the intracranial bifurcation.

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    Case 11. Anterior cerebral artery flow of 45 ml/min. Reverse flow was only 15 ml/min into the middle cerebral artery at test occlusion of the terminal internal carotid artery, showing poor collateral capacity of the anterior circle.

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