Objective: We describe the intraoperative findings and results of an indocyanine green (ICG) video angiographic study in a patient with a developmental venous anomaly of the petrous veins.
Clinical presentation: A 56-year-old man sought treatment after experiencing lacerating facial pain on the right side for almost 2 years. His neurological examination results were normal. A magnetic resonance imaging scan revealed the presence of a venous angioma in close relationship with the trigeminal nerve and the intrapontine tract of its fibers. The patient underwent a retrosigmoid craniotomy to explore the cerebellopontine angle. Near-infrared ICG video angiography was used to study the venous pattern of circulation. The venous angioma did not appear to be the source of any compression and was left untouched. At the entry zone of the nerve root, the trigeminal nerve was found to be compressed by a loop of the superior cerebellar artery, which was moved and repositioned away from the nerve.
Results: Near-infrared ICG video angiography disclosed an unexpected difference in filling time between developmental venous anomaly drainage veins and normal veins. The patient's pain resolved after microvascular decompression.
Conclusion: Near-infrared ICG video angiography was particularly accurate and useful in the study of the venous dynamic of circulation. Further studies are required to confirm the supposed capability of ICG video angiography to differentiate developmental venous anomaly drainage veins and normal veins. Although magnetic resonance imaging supported the involvement of the venous angioma in the etiopathogenesis of this patient's trigeminal pain, surgical exploration disclosed a different cause.