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.
A 33-year-old man with an unruptured right-occipital AVM underwent surgical treatment (Figures and ). Intraprocedural delay mapping provided a detailed color-coded image after opening of the dura (Figures and ); and the location of the nidus and main feeders was visualized. Based on the findings, we occluded the feeders and achieved complete removal of the AVM with accurate dissection plane between the nidus and normal brain tissue.