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 51-year-old woman who experienced massive intraventricular hemorrhage due to presence of a post-central parasagittal AVM, Spetzler & Martin grade 3, underwent surgery (Figures and ). In this case, we performed right frontoparietal craniotomy and approached the AVM via right interhemispheric route (). However, through the delay map, visualization of the precise structure of the AVM was not possible due to depth of the nidus and angle of the surgical approach (); moreover, due to swelling of the brain, exposure of the AVM was unstable.