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Background and importanceArteriovenous malformations (AVMs) are complex vascular anomalies that pose significant risks, including intracranial hemorrhage and neurological deficits. Surgical resection is the preferred treatment, requiring precise intraoperative imaging to ensure complete removal while preserving critical structures. This case report presents the first combined use of hyperspectral imaging (HSI) and indocyanine green video angiography (ICG VA) to visualize perfusion during brain AVM surgery, highlighting the potential benefits of these advanced imaging techniques.Case descriptionA 66-year-old male presented with chronic headaches but no neurological deficits. MRI revealed a superficial AVM in the left frontal lobe within the superior frontal sulcus, measuring approximately 2.4 cm. The AVM was fed by feeders from the pericallosal artery, callosomarginal artery, and middle cerebral artery (MCA) branches, with drainage through a dilated cortical vein into the superior sagittal sinus. Preoperative embolization of two MCA feeding branches was performed, followed by microsurgical resection with ICG VA and HSI.ConclusionsThis case report demonstrates the successful application of HSI and ICG VA in brain AVM surgery. The combined use of these technologies provided comprehensive intraoperative assessment, enhancing surgical precision and safety. The integration of HSI offers non-invasive, contrast-agent-free imaging, potentially improving outcomes by enabling detailed perfusion mapping. Future studies should explore the broader applications of these imaging modalities in neurovascular practice.

The most common manifestation of brain arteriovenous malformations (BAVM) is intracranial hemorrhage. The incidence of ruptured BAVM is 3.5 per 100,000 people per year. The mortality rate of ruptured BAVM within 1 month after diagnosis was 12.7%. Spontaneous thrombosis occurs in less than 1.5% of ruptured BAVMs. This phenomenon was still elusive. Up until now, the gold standard of imaging examination has been cerebral digital subtraction angiography (DSA), whose sensitivity and specificity reach 100%. We reported the spontaneous thrombosis of a ruptured deep BAVM. An 18-year-old woman presented with severe headache and vomiting. The patient also complained of seizures. There was no body weakness, skewed face, or slurred speech. Cerebral computed tomography (CT) showed extensive hemorrhage in the ventricular system and subarachnoid space. Cerebral DSA showed a left subcortical BAVM and was found to have spontaneous thrombosis 3 weeks later when the patient was about to be embolized. Spontaneous thrombosis of ruptured BAVM may occur after intracranial hemorrhage. In this patient, spontaneous thrombosis occurred within 3 weeks.

Abstract Background Endovascular approaches have been widely applied in patients with brain arterio-venous malformations (AVM). However, little is known regarding the risk factors for complications or predictors of procedure success. Herein, we report our experience regarding the outcomes of endovascular embolization of posterior fossa AVM, focusing on how angioarchitectural and hemodynamic characteristics of the AVM affect the post-intervention outcomes. 17 patients diagnosed with posterior cranial fossa AVM were enrolled and scheduled for endovascular interventions by Onyx or Histoacryl. Results Most patients had a single session (58.8%), while 29.4% had two sessions, 11.7% had three sessions. Total nidus obliteration was achieved in 52.9% of cases, while 35.3% and 11.8% of them had subtotal and partial occlusion, respectively. Postprocedural hematoma was encountered in 17.6% of cases. All preprocedural demographic characteristics did not have a significant impact on occlusion outcomes. However, some angioarchitecture criteria were associated with partial occlusion including large size, superficial or mixed drainage. No significant association was noted between patients criteria and the incidence of complications. Conclusion Endovascular interventions could be curative for brain AVM, with an accepted periprocedural morbidity rate. Proper knowledge of the angioarchitectural characteristics of these lesions could help us to predict lesions that carry high risk for complications or high chance for cure.

Abstract Endovascular embolization techniques are showing an extraordinary potential to treat patients suffering from complex neurovascular malformations. The embolization with liquid embolic agents via Onyx is a prominent approach to treat arteriovenous malformation (AVM). However, intraoperative reflux of the liquid agents can be very challenging and, thus, is impairing full success of endovascular treatment. A possible technique to prevent intraoperative endovascular reflux is the pressure-cooker technique (PCT) utilizing coils to build a wedge proximal to the AVM. Few modifications of the PCT have been developed in the recent years to improve effectiveness of embolization procedure. Hereby, we present a novel PCT modification utilizing extra-soft Kaneka coils and glue to build well-fitting wedges. After the application of extremely soft bare coils with high trackability, flexibility and crossability, liquid agents can be injected with reduced reflux. We think the pressure-cooker technique with extra-soft Kaneka coils enables more efficient embolization in even farther, tinier and more tortuous target vessels. This technical note presents two illustrative patient cases with treatment-refractory, high-grade cerebral arteriovenous malformations which were successfully treated via embolization with PCT in which the plug was formed with Kaneka coils.

Brain arteriovenous malformations (AVMs) are lesions thought to be primarily congenital in origin, consisting of fistulous connections of abnormal arteries and veins, without normal intervening capillary beds and no cerebral parenchyma between vessels. In the pediatric population, AVMs represent the most common cause of spontaneous intracranial hemorrhage (ICH), with a high recurrent bleeding risk. The aim of this paper is to report 2 cases of ruptured lobar AVMs in children, presenting with spontaneous ICH. Due to the patients’ neurological status, the only imaging examination performed preoperatively was a CT scan, showing intraparenchymal hemorrhage. Thus, there was no MRI/angiographic examination to prove the existence of a brain AVM prior to the surgical interventions. Also, the cerebral angiography performed after the surgery showed, in both patients, no signs of residual vascular malformations. Therefore, the diagnosis of AVM was certified by macroscopic and microscopic pathological findings, with no brain imaging suggestive of a vascular malformation.