ROLE OF INTRAOPERATIVE ANGIOGRAPHY IN THE SURGICAL-TREATMENT OF CEREBRAL ANEURYSMS

The benefit of using intraoperative angiography (IA) during aneurysm s urgery is still uncertain. Object. In this prospective study, the auth ors evaluate the radiographically demonstrated success of surgical tre atment in 151 consecutive patients harboring 173 aneurysms who selecti vely underwent IA examination. The authors also assess the frequency w ith which Vt led to repositioning of the aneurysm clip. Methods. Intra operative angiography was used selectively in this series, based on th e surgeon's concern about the potential for residual aneurysm, distal branch occlusion, or parent vessel stenosis. Specific variables were a nalyzed to determine their impact on the incidence of clip repositioni ng and the accuracy of IA was evaluated by direct comparison with post operative angiography (PA) in 90% of the cases in which IA was used. C onclusions. The selective use of IA led to successful treatment as sho wn by PA, with a low incidence of unexpected residual aneurysm (3.2%), distal branch occlusion (1.9%), and parent vessel stenosis (0%). Intr aoperative angiography led to immediate repositioning of the aneurysm clip in 27% of the cases. Anterior cerebral artery aneurysms required clip repositioning less often and superior hypophyseal artery aneurysm s required repositioning more often than aneurysms in other locations. Large and giant aneurysms required clip repositioning more often than small aneurysms; however, they were also more likely to display false success on IA as determined by PA. Aneurysms arising along the intern al carotid artery were more likely to display successful clipping on V t, as determined by PA, than were aneurysms in other locations. The re sults of this series support the selective use of LA in the treatment of complex aneurysms, particularly large and giant aneurysms as well a s superior hypophyseal artery aneurysms. As measured by PA, IA will im prove the outcome of these patients.