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.

Autor: Barbagallo GM; Neurosurgery Department, Policlinico 'G. Rodolico' University Hospital, via Santa Sofia 78, 95123, Catania, Italy. Electronic address: giuseppebarbagal@hotmail.com., Certo F; Neurosurgery Department, Policlinico 'G. Rodolico' University Hospital, via Santa Sofia 78, 95123, Catania, Italy., Caltabiano R; Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania, via Santa Sofia 78, 95123 Catania, Italy., Chiaramonte I; Radiology Department, Policlinico 'G. Rodolico' University Hospital, via Santa Sofia 78, 95123 Catania, Italy., Albanese V; Neurosurgery Department, Policlinico 'G. Rodolico' University Hospital, via Santa Sofia 78, 95123, Catania, Italy., Visocchi M; Institute of Neurosurgery, Catholic University of Rome, Italy.
Jazyk: angličtina
Zdroj: Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2015 Nov; Vol. 138, pp. 45-51. Date of Electronic Publication: 2015 Jul 26.
DOI: 10.1016/j.clineuro.2015.07.016
Abstrakt: 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.
(Copyright © 2015 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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