Over the last 30 years,
perfluorocarbons (PFCs) have been extensively investigated as
oxygen carriers. Early studies indicated that these compounds could be used as
blood substitutes or
protective agents against
ischemia. Adverse characteristics such as instability, short intravascular half-life, and uncertainties concerning possible toxicity precluded wide clinical application. However, advances in PFC technology have led to the development of improved second-generation
oxygen carriers that incorporate well-tolerated emulsifiers (egg-yolk
phospholipids). The authors review recent developments in this field and consider the potential role of PFCs in future neurosurgical practice. Diagnostic applications could include their use to assess cerebral blood flow, local
oxygen tension, and brain metabolism or to achieve enhanced imaging and precise staging of inflammatory, neoplastic, or
vascular disease processes by means of computerized tomography, ultrasonography, and magnetic resonance studies. Therapeutic applications could include cerebral protection, an adjunctive role in
radiotherapy of malignant
brain tumors, protection against
air embolism, the preservation of organs for
transplantation, and ventilatory support in head-injured patients with compromised lung function. In addition, PFCs have been used successfully as a tool in ophthalmic microsurgery and potentially they could fulfill a similar role in microneurosurgery.