Flow-assisted surgical technique in cerebrovascular surgery

BackgroundCerebrovascular surgery is a technically challenging subspecialty of neurosurgery. A flow-based approach to cerebrovascular surgery can help to optimize neurosurgical interventions.MethodsDirect intraoperative flow measurements can be made using a quantitative ultrasonic microvascular flow probe. In this article, we review the applications and utility of the FAST in aneurysm and EC-IC bypass surgery.ResultsIn aneurysm surgery, flow measurements provide a quick and repeatable method to assess vessel patency and avoid complications related to vascular compromise. In bypass for flow augmentation in the setting of ischemia, flow measurements assess bypass patency and can assess the physiologic success of the bypass strategy. In bypass for flow replacement in the setting of planned vessel sacrifice, flow measurements can measure the flow deficit resulting from the vessel occlusion, assess the adequacy of in situ donor vessels, and confirm the ultimate adequacy of the bypass at the completion of surgery.ConclusionsThe FAST strategy provides a useful approach to optimizing decision making and outcomes during cerebrovascular surgery.