Abstract
Cerebral cavernous malformations (CCMs) are known to be angiographically occult malformations with low perfusion of blood flow.5 Near-infrared indocyanine green (ICG) video angiography allows for intraoperative observation and documentation of blood flow in large and small vessels.2,4Developmental venous anomalies (DVAs) are thought to be the most common cerebral vascular abnormality.2,3 The opportunity to differentiate intraoperatively between normal veins and DVA draining veins might be useful in the event of a possible venous sacrifice. Coagulation of the DVA can lead to devastating consequences. ICG reliably demonstrates margins between CCM and the venous structures.1,2 For these reasons, we decided to use ICG video angiography in this patient.The video can be found here: https://youtu.be/9MONn0GkO4U.
Highlights
Cerebral cavernous malformations (CCMs) are known to be angiographically occult malformations with low perfusion of blood flow.[5]
We present this video of an awake craniotomy for the resection of a Broca-sited cavernoma with a developmental venous anomaly using indocyanine green (ICG) green video angiography
1:25 As stated in the title, we chose to do an awake craniotomy, with laryngeal mask, phenytoin the day prior to the surgery to prevent per operatory seizures, local anesthetic on the surgical wound, and block on the Mayfield points
Summary
Cerebral cavernous malformations (CCMs) are known to be angiographically occult malformations with low perfusion of blood flow.[5]. We present this video of an awake craniotomy for the resection of a Broca-sited cavernoma with a developmental venous anomaly using ICG green video angiography. Patient with a history of seizures since more than 5 years that showed worsening on the episodes and enlargement of the cavernoma in follow-up. We can appreciate the large DVA on the medial aspect of the cavernoma. FLAIR protocol shows the hyperintensity, classic cavernoma appearance.
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