Awake craniotomy for the resection of a Broca-sited cerebral cavernous malformation with a developmental venous anomaly using near-infrared indocyanine green video angiography

Issael Ramirez; Paldor Iddo; Sergey Spektor

doi:10.3171/2019.7.FocusVid.18626

Awake craniotomy for the resection of a Broca-sited cerebral cavernous malformation with a developmental venous anomaly using near-infrared indocyanine green video angiography

Neurosurg Focus Video. 2019 Jul 1;1(1):V9. doi: 10.3171/2019.7.FocusVid.18626. eCollection 2019 Jul.

Authors

Issael Ramirez¹, Paldor Iddo¹, Sergey Spektor¹

Affiliation

¹ Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel.

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.^2,4 Developmental 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.

Keywords: DVA; Ojemann; awake; cavernoma; motor speech cortex; video.