Abstract | OBJECTIVE: To illustrate the usefulness of intraoperative indocyanine green videoangiography (ICG-VA) to identify the nidus and feeders of a small cerebellar AVM resembling a cavernous hemangioma. To review the unique features regarding the overlay between these two vascular malformations and to highlight the importance to identify with ICG-VA, and treat accordingly, the arterial and venous vessels of the AVM. METHODS: A 36-year old man presented with bilateral cerebellar hemorrhage. MRI was equivocal in showing an underlying vascular malformation but angiography demonstrated a small, Spetzler-Martin grade I AVM. Surgical resection of the AVM with the aid of intraoperative ICG-VA was performed. After hematoma evacuation, pre-resection ICG-VA did not reveal tortuous arterial and venous vessels in keeping with a typical AVM but rather an unusual blackberry-like image resembling a cavernous hemangioma, with tiny surrounding vessels. Such intraoperative appearance, which could also be the consequence of a "leakage" of fluorescent dye from the nidal pathological vessels, with absent blood-brain barrier, into the surrounding parenchymal pathological capillary network, is important to be recognized as an unusual AVM appearance. RESULTS: Post-resection ICG-VA confirmed the AVM removal, as also shown by postoperative and 3-month follow-up DSAs. CONCLUSIONS: Despite technical limitations associated with ICG-VA in post- hemorrhage AVMs, this case together with the intraoperative video, demonstrates the useful role of ICG-VA in identifying small AVMs with peculiar features.
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Authors | Giuseppe M V Barbagallo, Francesco Certo, Rosario Caltabiano, Ignazio Chiaramonte, Vincenzo Albanese, Massimiliano Visocchi |
Journal | Clinical neurology and neurosurgery
(Clin Neurol Neurosurg)
Vol. 138
Pg. 45-51
(Nov 2015)
ISSN: 1872-6968 [Electronic] Netherlands |
PMID | 26276727
(Publication Type: Journal Article, Review)
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Copyright | Copyright © 2015 Elsevier B.V. All rights reserved. |
Chemical References |
- Coloring Agents
- Indocyanine Green
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Topics |
- Adult
- Brain Neoplasms
(diagnostic imaging)
- Cerebral Angiography
(methods)
- Coloring Agents
- Cranial Fossa, Posterior
(abnormalities)
- Craniotomy
- Diagnosis, Differential
- Hemangioma, Cavernous
(diagnostic imaging)
- Humans
- Indocyanine Green
- Intracranial Arteriovenous Malformations
(diagnostic imaging, surgery)
- Male
- Video-Assisted Surgery
(methods)
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