Intraoperative Angiography Evaluation of the Microsurgical Clipping of Unruptured Cerebral Aneurysms.

Abstract

Intraoperative angiography evaluation of the clippings of cerebral aneurysms was investigated in a series of 38 consecutive patients with unruptured cerebral aneurysms to determine any favorable impact on the outcome. Unexpected findings including major arterial occlusion or residual aneurysm were identified. Specific variables such as the size and site of aneurysm were analyzed to determine the impact on clinical outcome and the incidence of clip modification. There were 11 large and 27 small aneurysms in this series. Mortality and permanent morbidity after microsurgical clipping were 0.0% and 2.6%, respectively. Unexpected angiographic findings necessitating clip repositioning consisted of residual aneurysm in two cases and distal branch occlusion or parent vessel stenosis in four. The need for clip modification was significantly higher for large than for small aneurysms (p ＝ 0.007), and the rate of clip adjustment increased with increasing aneurysm size (p ＝ 0.008). Intraoperative assessment prior to wound closure allows for the recognition and correction of defects and decreases the risk of postoperative complications. Intraoperative angiography may become important in the microsurgical clipping of unruptured cerebral aneurysms, especially large aneurysms.

Intraoperative assessment of anterior circulation aneurysms using the indocyanine green video angiography technique

“…4,5 Thus, DSA is not yet practical for routine use in most neurosurgery centers. [6][7][8] Because ICG angiography can provide real-time information on blood flow, so that the position of clips can be adjusted immediately, minimizing the ischemic time of the brain, it has the potential to be used routinely in aneurysm surgery. Intraoperative microvascular Doppler ultrasonography (MDU) is a non-invasive and reliable method to evaluate whether aneurysm clipping is complete or incomplete.…”

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

“…The use of intraoperative angiography to verify complete aneurysm obliteration at the time of surgery and verify the patency of branch vessels has become more widespread, especially at tertiary centers. [237][238][239][240][241] Case series have demonstrated unexpected findings (such as vessel occlusions or residual aneurysms) in ≈7% to 12% of cases, 237,239,242 leading to alterations in clipping and thus providing an indirect validation of its value. Because of the time, expertise, and expense associated with intraoperative angiography, other tools have also emerged that can provide more immediate feedback related particularly to vessel compromise.…”

Head and Neck Extension-Fixation With a Head Frame for Exposure of the Distal Internal Carotid Artery in Carotid Endarterectomy-Technical Note-

“…In addition, the radiolucent head frame allows intraoperative angiography in every direction, as previously reported. [15][16][17][18][19][20][21] Therefore, although head frame fixation using pins seems a little invasive, there are a number of advantages.…”