A. Popadic et al., The value of intraoperative angiography in surgery of intracranial aneurysms: a prospective study in 126 patients, NEURORADIOL, 43(6), 2001, pp. 466-471
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%.