Utility, safety, and accuracy of intraoperative angiography in the surgical treatment of aneurysms and arteriovenous malformations

BACKGROUND AND PURPOSE: The role of intraoperative angiography in the treat ment of neurovascular lesions has remained extremely controversial, We retr ospectively reviewed the utility, safety, and accuracy of intraoperative an giography to ascertain its effect on the treatment of patients with neurova scular lesions. METHODS: We reviewed the results of intraoperative angiography in 91 patien ts treated surgically for intracranial aneurysms and in 98 patients treated surgically for arteriovenous malformations (AVMs), All treatments were com pleted at two major teaching hospitals between October 1987 and March 1995, RESULTS: The initial angiographic findings caused the surgical procedure to be modified in 24 (26%) of the patients with aneurysms and in 28 (29%) of the patients with AVMs, Analysis of the final angiographic sequence showed residual lesions in nine (10%) of the aneurysm cases and in eight (8%) of t he AVM cases. The imperfect angiographic results were deemed acceptable bec ause there was either evidence of collateral flow when the parent vessel wa s occluded or the risk of further surgical modification was considered more dangerous than the abnormality itself, Seven patients suffered complicatio ns, of which only one had permanent neurologic sequelae: a CNS complication rate of 0.5%, Comparison of the intraoperative angiographic findings with those of postoperative studies revealed four false-negative results (5.2%). CONCLUSION: Intraoperative angiography is an important component in the tre atment of patients with intracranial vascular lesions, It is effective and can be carried out with low risk in this patient population.