Case 3: A 62-year-old woman presented with progressive headache and vertigo and was diagnosed as having 2 aneurysms arising from right A2-anterior communicating artery junction, one projecting anteroinferiorly and the other projecting medially []. After clipping of the first aneurysm, micro-Doppler examination detected no flow in the aneurysm. The arterial phase in the ICG-VA also showed lack of flow into the aneurysm and normal flow in the nearby perforating artery. However, the venous phase showed a glimmer of fluorescence visible in the aneurysm sac [], suggestive of residual filling of the aneurysm. The corresponding color map showed a portion of the aneurysm with blue color and a delayed ascending curve (purple color) was detected in the intensity [Figure and ], thus confirming a residual aneurysm. The clip was then readjusted and ICG-VA was repeated. This time it showed complete absence of flow within the aneurysm. A postoperative 3D-CTA demonstrated complete obliteration of the aneurysm.
Figure – shows a 62-year-old man diagnosed with a cerebellar AVM with feeders from left superior and posterior inferior cerebellar arteries. After exposing the lesion, ICG-VA demonstrates AVM vessels []. illustrates the same view after being rendered by the FLOW 800. Early appearing blood flow is showed in red and late appearing flow in blue. After selecting ROIs for the software, semi-quantitative characteristics of the blood flow in desired vessels were analyzed and demonstrated in curves by the FLOW 800 []. After microsurgical resection of the AVM was complete, ICG-VA showed no remnant of the AVM []. Visual color map showed hemodynamic changes after AVM resection [] in contrast with preresection status []. Furthermore, analytical graphs show changes in flow parameters immediately after AVM resection [Figure and ]. To make it easy to understand, we removed all curves of except for one to demonstrate image analysis performed with ImageJ software []. Time to peak, rise time, and MFI are all showed on the curve. Although CBFI is also calculated, we should notice that this curve is derived from a venous blood flow not brain parenchyma and this index is demonstrated as an example to explain its calculation.