The value of intraoperative angiography in surgery of intracranial aneurysms: a prospective study in 126 patients

The value of intraoperative digital subtraction angiography in surgery for intracranial aneurysms, the benefits and cost-effectiveness are a matter of discussion. We prospectively studied 126 patients with 144 aneurysms, most on the anterior intracranial circulation, who underwent clipping and intra operative angiography. Follow-up was 25.4 +/- 13.1 months. We tried to work out the indications for intraoperative angiography of the anterior circula tion and its cost-effectiveness. In 10.3 % of patients (9 % per aneurysm) u nexpected findings were shown by intraoperative angiography: inadequately c lipped aneurysms in 10 (7.9 %), a completely unclipped aneurysm in one (0.8 %) and occluded major arteries in two (1.6 %), A broad neck was a variable of statistical significance for inadequate clipping or stenosis or occlusi on of an adjacent vessel. There was a strong trend for aneurysms more than 15 mm in diameter to be "risky". Their site was not a predictive factor. We believe that intraoperative angiography is indicated in surgery not only o n large and giant aneurysms, but also broad-based aneurysms of the anterior cerebral circulation regardless of their size. It is cost-effective compar ed to postoperative angiography, The rate of stroke in our hands was 0.8%.