case_images: PMC10757834_01
case_images: Case presentation. (A) Computed tomography angiography axial cut showing cerebral hematoma on the right-hand side (arrowheads) and associated arteriovenous malformation (AVM) nidus (arrow). (B) Anterior posterior projection of the preoperative digital subtraction angiography (DSA) after right vertebral artery injection displaying the AVM nidus being fed by the anterior inferior cerebellar artery (AICA) branches (arrows). (C) Oblique projection of the postoperative DSA after right vertebral artery injection showing the intact en-passant AICA (arrowheads) and the AVM clip on the previous AVM feeder (circle). (D) Anterior posterior projection of the DSA after right vertebral artery projection highlighting the intact en-passant AICA (arrows).
case_images: fsurg-10-1285758-g001.jpg
case_images: PMC10757834_01_fsurg-10-1285758-g001.jpg
case_images: F1
case_images: A computed tomography angiography (CTA) was performed in the emergency setup revealing a cerebellar hematoma and associated small AVM nidus (Figure 1A). The AVM was fed by en-passant branches of the anterior inferior cerebellar artery (AICA) (Figure 1B). The AVM nidus was progressively devascularized by disconnecting its AICA feeders but preserving the main en-passant AICA cortical branch (Figures 1C,D).
case_images: White light image of the surgical field pre resection (A) and associated laser speckle 233 contrast imaging (LSCI) overlay blood flow map (B). (C) Corresponding Flow 800 delay map (Carl 234 Zeiss Meditec, Oberkochen, Germany) computed <1 min after (B). White light image of the surgical field post resection (D) and associated LSCI overlay blood flow map (E). The clip is positioned on the arteriovenous malformation feeder leaving the en-passant branches (region of interest (ROI) 2 & 3) patent. The four ROIs are depicted and numbered on the white light and LSCI overlay images. (F) Grouped bar graph comparison between the normalized relative cerebral blood flow values in the vessel contained in the four ROIs pre and post resection. The inverse correlation time values computed from the speckle contrast are normalized to the pre resection data in ROI 1. A two-sample paired t-test was used to evaluate significance (p < 0.0001 for all four ROIs).
case_images: fsurg-10-1285758-g002.jpg
case_images: PMC10757834_01_fsurg-10-1285758-g002.jpg
case_images: F2
case_images: We utilized LSCI to measure rCBF before and after complete AVM resection as shown in Figure 2. Notably, LSCI measured a decrease in flow (p < 0.001) in the initially arterialized vein (ROI 1) pre- and post-resection (Figure 2F) while capturing the absence of flow in the cauterized vessel (ROI 4).
case_images: Post resection laser speckle contrast imaging (LSCI) overlay video demonstrating real time blood flow changes in response to the temporary occlusion on the artery. (A) LSCI overlay baseline frame (t = 0s) moments before complete artery occlusion. The white arrow highlights the occluded artery while the black arrow shows its downstream vascular region. (B-D) LSCI overlay frames at different timepoints during artery occlusion.
case_images: fsurg-10-1285758-g003.jpg
case_images: PMC10757834_01_fsurg-10-1285758-g003.jpg
case_images: F3
case_images: LSCI also accurately measured changes in blood flow due to temporary forceps occlusion with high temporal sensitivity (Figure 3) and informed about the downstream vascular regions supplied by the occluded artery.