Abstract
We describe a case in which intraoperative indocyanine green videoangiography (ICG-VA) enabled the detection of hyperemia in the brain adjacent to the nidus during cerebral arteriovenous malformation (AVM) surgery. A 43-year-old woman presented with paresis and sensory disturbance in her left upper extremity, which revealed a subcortical hematoma in the right parietal lobe due to a small ruptured AVM. Craniotomy was performed. During surgery, despite resection of the nidus, a persistent red draining vein was observed. ICG-VA demonstrated that the reddish blood flow was not from the residual nidus but from the adjacent brain, suggesting hyperemia. The procedure was completed without additional manipulation. The paresis was almost completely reversed, and the patient was discharged 2 weeks after surgery. Interestingly, the observed hyperemia after nidus resection corresponded to an area where the pial venous reflux from the draining vein was observed before the resection, and it is possible that chronic venous hypertension contributed to this post-resection hyperemia. During AVM surgery, ICG-VA may be useful in evaluating changes in blood flow not only in malformation but also in adjacent brain regions.
