Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy

Restricted access

Object. Indications for intraoperative angiography during aneurysm surgery remain unclear. To define its use, the authors report the results of a prospective study in which this modality was used in all patients undergoing surgery for intracranial aneurysms.

Methods. Intraoperative angiography was performed prospectively in the surgical treatment of 517 consecutive aneurysms regardless of the lesion's location, size, or complexity. In 64 (12.4%) of 517 aneurysms intraoperative angiography findings prompted a change in surgical treatment. Residual aneurysm (47%) was the most frequent finding leading to clip revision. In 44% of cases, intraoperative angiography revealed vessel compromise. Surgery for aneurysms of the proximal internal carotid artery (ICA) was the most frequently altered, with lesions located at the superior hypophyseal artery (SHA) and clinoidal region having the highest revision rates, eight (40%) of 20 and eight (44%) of 18, respectively. Aneurysm size predicted the need for revision; giant aneurysms (> 24 mm) underwent revision in nine (29%) of 31 cases, whereas large aneurysms (15–24 mm) were revised in 12 (22%) of 54 cases. In a multivariate logistic regression model, factors related to increased revision rates included the SHA and clinoidal locations, as well as giant and large size. Ninety-five patients underwent both intraoperative and postoperative angiography. Five discrepancies were noted (95% accuracy); four were flow-related and one involved a previously unrecognized residual aneurysm. Complications attributable to intraoperative angiography occurred in 0.4% of cases.

Conclusions. Proximal ICA location and large aneurysm size significantly predicted revision of surgery following intraoperative angiography. Unexpected findings, even in less complex locations, are frequently identified on intraoperative angiography. Low complication rates, high accuracy, and the unexpected need for clip readjustments favor a more widespread use of intraoperative angiography.

Article Information

Contributor Notes

Address reprint requests to: Sherry A. Ballenger, Editor, Department of Neurological Surgery, Emory University, 1365-B Clifton Road, Suite 6400, Atlanta, Georgia 30322. email: sherry_ballenger@emory.org.
Headings
References
  • 1.

    Alexander TDMacdonald RLWeir Bet al: Intraoperative angiography in cerebral aneurysm surgery: a prospective study of 100 craniotomies. Neurosurgery 39:10181996Alexander TD Macdonald RL Weir B et al: Intraoperative angiography in cerebral aneurysm surgery: a prospective study of 100 craniotomies. Neurosurgery 39:10–18 1996

    • Search Google Scholar
    • Export Citation
  • 2.

    Barrow DLBoyer KLJoseph GJ: Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 30:1531591992Barrow DL Boyer KL Joseph GJ: Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 30:153–159 1992

    • Search Google Scholar
    • Export Citation
  • 3.

    Derdeyn CPMoran CJCross DT IIIet al: Intracranial aneurysm: anatomic factors that predict the usefulness of intraoperative angiography. Radiology 205:3353391997Derdeyn CP Moran CJ Cross DT III et al: Intracranial aneurysm: anatomic factors that predict the usefulness of intraoperative angiography. Radiology 205:335–339 1997

    • Search Google Scholar
    • Export Citation
  • 4.

    Drake CGVanderlinden RG: The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg 27:2262381967Drake CG Vanderlinden RG: The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg 27:226–238 1967

    • Search Google Scholar
    • Export Citation
  • 5.

    Giannotta SLLitofsky NS: Reoperative management of intracranial aneurysms. J Neurosurg 83:3873931995Giannotta SL Litofsky NS: Reoperative management of intracranial aneurysms. J Neurosurg 83:387–393 1995

    • Search Google Scholar
    • Export Citation
  • 6.

    Heros RC: Comment on Alexander TD, Macdonald RL, Weir B, et al: Intraoperative angiography in cerebral aneurysm surgery: a prospective study of 100 craniotomies. Neurosurgery 39:10181996Heros RC: Comment on Alexander TD Macdonald RL Weir B et al: Intraoperative angiography in cerebral aneurysm surgery: a prospective study of 100 craniotomies. Neurosurgery 39:10–18 1996

    • Search Google Scholar
    • Export Citation
  • 7.

    Heros RC: Comment on Munshi I, Macdonald RL, Weir BK: Intraoperative angiography of brain arteriovenous malformations. Neurosurgery 45:4914991999Heros RC: Comment on Munshi I Macdonald RL Weir BK: Intraoperative angiography of brain arteriovenous malformations. Neurosurgery 45:491–499 1999

    • Search Google Scholar
    • Export Citation
  • 8.

    Le Roux PDElliott JPEskridge JMet al: Risks and benefits of diagnostic angiography after aneurysm surgery: a retrospective analysis of 597 studies. Neurosurgery 42:124812551998Le Roux PD Elliott JP Eskridge JM et al: Risks and benefits of diagnostic angiography after aneurysm surgery: a retrospective analysis of 597 studies. Neurosurgery 42:1248–1255 1998

    • Search Google Scholar
    • Export Citation
  • 9.

    Macdonald RLWallace MCKestle JRW: Role of angiography following aneurysm surgery. J Neurosurg 79:8268321993Macdonald RL Wallace MC Kestle JRW: Role of angiography following aneurysm surgery. J Neurosurg 79:826–832 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Origitano TCSchwartz KAnderson Det al: Optimal clip application and intraoperative angiography for intracranial aneurysms. Surg Neurol 51:1171281999Origitano TC Schwartz K Anderson D et al: Optimal clip application and intraoperative angiography for intracranial aneurysms. Surg Neurol 51:117–128 1999

    • Search Google Scholar
    • Export Citation
  • 11.

    Payner TDHorner TGLeipzig TJet al: Role of intraoperative angiography in the surgical treatment of cerebral aneurysms. J Neurosurg 88:4414481998Payner TD Horner TG Leipzig TJ et al: Role of intraoperative angiography in the surgical treatment of cerebral aneurysms. J Neurosurg 88:441–448 1998

    • Search Google Scholar
    • Export Citation
  • 12.

    Rauzzino MJQuinn CMFisher WS III: Angiography after aneurysm surgery: indications for “selective” angiography. Surg Neurol 49:32411998Rauzzino MJ Quinn CM Fisher WS III: Angiography after aneurysm surgery: indications for “selective” angiography. Surg Neurol 49:32–41 1998

    • Search Google Scholar
    • Export Citation
  • 13.

    Sekhar LNBucur SDBank WOet al: Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results. Neurosurgery 44:120712241999Sekhar LN Bucur SD Bank WO et al: Venous and arterial bypass grafts for difficult tumors aneurysms and occlusive vascular lesions: evolution of surgical treatment and improved graft results. Neurosurgery 44:1207–1224 1999

    • Search Google Scholar
    • Export Citation
  • 14.

    Tang GMcInerney JCawley Met al: Cost effectiveness of routine intraoperative angiography during aneurysm surgery. Neurosurgery 49:5182001 (Abstract)Tang G McInerney J Cawley M et al: Cost effectiveness of routine intraoperative angiography during aneurysm surgery. Neurosurgery 49:518 2001 (Abstract)

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 296 251 17
Full Text Views 170 33 3
PDF Downloads 46 16 3
EPUB Downloads 0 0 0
PubMed
Google Scholar