ANGIOGRAPHY AFTER ANEURYSM SURGERY - INDICATIONS FOR SELECTIVE ANGIOGRAPHY

BACKGROUND The need for postoperative cerebral angiography to confirm clip placement is largely a matter of the individual surgeon's prefere nce, but in an atmosphere of limited health care resources and rising costs this attitude may need to be changed. METHODS A series of 312 in tracerebral aneurysms harbored in 227 consecutive patients were clippe d by a single surgeon (WF) and studied with postoperative selective an giography. Clues were sought to identify which (if any) aneurysms were prone to require postoperative recognition of incomplete or inaccurat e clipping. We examined aneurysmal size, patient's sex, age,preoperati ve Hunt/Hess Grade, and Fisher CT grade, to determine their relationsh ip to poor surgical clipping results (residual aneurysm or major vesse l occlusion). RESULTS There were 13 cases of residual aneurysm (4.2%) and one case of major vessel occlusion (0.3%). Deep midline aneurysms (posterior circulation, anterior communicating artery) and ophthalmic (paraophthalmic) artery regions formed a group of patients with an inc reased risk of imperfect clip placement (8.2%; 13/157) as compared to patients with aneurysms in other locations (0.6%; 1/155) (p < 0.05). I n addition, incompletely obliterated aneurysms proved to have a high r ehemorrhage rate in this series. CONCLUSIONS A retrospective analysis revealed that deep midline aneurysms are more prone to inadequate clip ping, and therefore, as a bare minimum represent aneurysms requiring c onfirmatory postoperative evaluation. This contemporary series can be used as a basis to compare the results from intraoperative angiography . (C) 1998 by Elsevier Science Inc.