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.