Role of intraoperative indocyanine green video-angiography to identify small, posterior fossa arteriovenous malformations mimicking cavernous angiomas. Technical report and review of the literature on common features of these cerebral vascular malformations

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• 作者：Giuseppe M.V. Barbagallo<sup>asup><sup> ; sup><sup>giuseppebarbagal@hotmail.com" class="auth_mail" title="E-mail the corresponding authorsup> ; Francesco Certo<sup>asup> ; Rosario Caltabiano<sup>bsup> ; Ignazio Chiaramonte<sup>csup> ; Vincenzo Albanese<sup>asup> ; Massimiliano Visocchi<sup>dsup>
• 关键词：Angiography ; Arterio-venous malformation ; Hemorrhage ; Indocyanine green videoangiography ; Posterior fossa ; Vascular malformation
• 刊名：Clinical Neurology and Neurosurgery
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：138
• 期：Complete
• 页码：45-51
• 全文大小：2388 K

文摘

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.

sSec_2">Methods

spar0010">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&ndash;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.

sSec_3">Results

spar0015">Post-resection ICG-VA confirmed the AVM removal, as also shown by postoperative and 3-month follow-up DSAs.

sSec_4">Conclusions

spar0020">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.