INTRAOPERATIVE DIGITAL SUBTRACTION ANGIOGRAPHY - A REVIEW OF 112 CONSECUTIVE EXAMINATIONS

PURPOSE: To examine the effect of intraoperative angiography on neuros urgery and angiographic technical success, safety, and accuracy. METHO DS: Angiographic studies, surgical reports, and hospital records were reviewed retrospectively for 112 consecutive procedures in which intra operative angiography was performed during neurosurgery. The results o f conventional postoperative angiograms in 28 of the 112 procedures we re also reviewed. A portable digital subtraction angiography unit was used for all patients. Decisions in the operating room were based on r eview of stored videotaped images. RESULTS: Eighteen studies were obta ined in 14 patients after arteriovenous malformation resection. Unsusp ected residual nidus was identified and resected in 3 patients. The in traoperative angiogram also altered therapy for 2 patients undergoing staged resections of arteriovenous malformations. Sixty-six studies we re performed after aneurysm clipping, with clinically significant chan ges in surgical therapy made in 5 patients. Of 28 examinations after c arotid endarterectomy, 3 led to revision. Two complications of angiogr aphy occurred. One led to a permanent neurologic deficit, yielding a c omplication rate of 1.5% for stroke. Two examinations could not be com pleted because of technical factors. Two false-negative examinations w ere identified on postoperative studies. One patient with a normal int raoperative study after carotid endarterectomy thrombosed the repaired internal carotid artery after surgery. CONCLUSIONS: Intraoperative an giography altered surgery in 13 of 112 procedures on 104 patients. Thi s study supports the use of intraoperative angiography in arteriovenou s malformation resection and in complex aneurysm surgery, but not for routine carotid endarterectomy.