Advancements in flow measurement techniques within cerebrovascular neurosurgery

PURPOSE: The cerebral vasculature operates as a highly dynamic system that actively regulates blood flow to maintain the brain's physiological equilibrium while providing essential support for its functions. Therefore, enhancing our understanding of how cerebral blood flow is controlled, modified, or adapts in the presence of specific pathologies-such as stroke, Moyamoya disease, arteriovenous malformations (AVMs), or aneurysms-is critical for accurately evaluating the effects of these conditions and for developing effective therapeutic strategies for patients. MATERIALS AND METHODS: A comprehensive literature review was performed with the aim of exploring recent advances in neuroimaging techniques used to assess hemodynamic alterations in the cerebral vasculature. RESULTS: We discuss the clinical applications of 3D time-of-flight magnetic resonance angiography (MRA), arterial spin labelling (ASL), 4D MRA, dynamic susceptibility contrast (DSC)-weighted bolus-tracking MR, perfusion computed tomography (CT), single-photon emission computed tomography (SPECT), quantitative digital subtraction angiography (DSA), and computational fluid dynamics (CFD) in the evaluation of aneurysms, stroke, AVMs, and Moyamoya disease, as relevant techniques in this field. Specific case examples of the benefit of each type of imaging were also explored. CONCLUSIONS: By investigating these imaging modalities and their novel uses in understanding and guiding treatment, this review aims to offer a valuable resource for determining the most relevant parameters to be analysed when making clinical decisions regarding the management of these cerebrovascular conditions.