Intraoperative Angiogram Through External Carotid Artery Branches During Craniotomy for Arteriovenous Malformations: 2-Dimensional Operative Video.

Intraoperative angiogram is commonly performed during craniotomy for intracranial arteriovenous malformation (AVM) lesions to confirm angiographic cure before completing the procedure. This practice reduced the need of subsequent reoperation for unexpected residual nidus after initial microscopic gross total excision.1 Conventional vascular access for angiogram is achieved through the common femoral artery or, more recently, through the radial artery.2 We present the technique and utility of using external carotid artery branches for intraoperative angiogram. The superficial temporal artery is routinely exposed during anterior fossa craniotomies, and the occipital artery or posterior auricular artery is exposed during posterior fossa craniotomies. These arteries can be cannulated microsurgically with the Seldinger technique, and selective ipsilateral internal carotid artery and external carotid artery angiogram can be performed by using J-shaped diagnostic catheters. This provides a useful alternative access for intraoperative angiograms for AVMs with ipsilateral carotid arterial supply. This technique is illustrated with 2 patients, including a frontal AVM with angiogram through the superficial temporal artery and a transverse sinus dural arteriovenous fistula with angiogram through the posterior auricular artery. The patients consented to the procedures.