• Giuseppe M V Barbagallo, Francesco Certo, Rosario Caltabiano, Ignazio Chiaramonte, Vincenzo Albanese, and Massimiliano Visocchi.
• Neurosurgery Department, Policlinico "G. Rodolico" University Hospital, via Santa Sofia 78, 95123, Catania, Italy. Electronic address: giuseppebarbagal@hotmail.com.
• Clin Neurol Neurosurg. 2015 Nov 1; 138: 45-51.

ObjectiveTo illustrate the usefulness of intraoperative indocyanine green videoangiography (ICG-VA) to identify the nidus and feeders of a small cerebellar AVM resembling a cavernous hemangioma. To review the unique features regarding the overlay between these two vascular malformations and to highlight the importance to identify with ICG-VA, and treat accordingly, the arterial and venous vessels of the AVM.MethodsA 36-year old man presented with bilateral cerebellar hemorrhage. MRI was equivocal in showing an underlying vascular malformation but angiography demonstrated a small, Spetzler-Martin grade I AVM. Surgical resection of the AVM with the aid of intraoperative ICG-VA was performed. After hematoma evacuation, pre-resection ICG-VA did not reveal tortuous arterial and venous vessels in keeping with a typical AVM but rather an unusual blackberry-like image resembling a cavernous hemangioma, with tiny surrounding vessels. Such intraoperative appearance, which could also be the consequence of a "leakage" of fluorescent dye from the nidal pathological vessels, with absent blood-brain barrier, into the surrounding parenchymal pathological capillary network, is important to be recognized as an unusual AVM appearance.ResultsPost-resection ICG-VA confirmed the AVM removal, as also shown by postoperative and 3-month follow-up DSAs.ConclusionsDespite technical limitations associated with ICG-VA in post-hemorrhage AVMs, this case together with the intraoperative video, demonstrates the useful role of ICG-VA in identifying small AVMs with peculiar features.Copyright © 2015 Elsevier B.V. All rights reserved.

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