Optimal clip application and intraoperative angiography for intracranial aneurysms

Origitano, Thomas C.; Schwartz, K.; Anderson, Douglas; Azar-Kia, Behrooz; Reichman, Orna

doi:10.1016/s0090-3019(97)00529-6

Cited by 73 publications

(54 citation statements)

References 14 publications

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“…Furthermore, the delay in obtaining information about blood flow may be unacceptable and the complication rate of angiography is by no means negligeble (1.7 to 2.9%) 8,9 . Nevertheless, several studies have documented the rates of vessel occlusion or clip adjustment based on angiographic findings [5][6][7]10,11 . In a series of 66 patients who underwent postoperative angiography, Macdonald et al 5 reported that there were unexpected stenosis in nine out of 78 (11.5%) patients, resulting in six strokes and two deaths (10.3%).…”

Section: Discussionmentioning

confidence: 99%

“…Origitano et al 6 reported on the rate of clip adjustment made on the basis of intraoperative angiography in 40 consecutive patients harboring 54 aneurysms, 52 of which were clipped. Intraoperative angiography prompted clip adjustment in 18 (34%) of the 52 aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Angiographic data provided in the literature indicate that an intraoperative method of measuring cerebral vessel flow during aneurysm surgery would enable early detection of compromised flow and may reduce the risk of permanent neurological deficit [5][6][7] . In this report we describe the use of a ultrasonic perivascular microflow probe for quantitative vessel-flow measurement during middle cerebral artery (MCA) bifurcation aneurysm surgery.…”

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confidence: 99%

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Clip readjustment in aneurysm surgery after flow evaluation using the ultrasonic perivascular probe: case report

Fagundes-Pereyra

Hoffman

Misra

et al. 2005

Arq. Neuro-Psiquiatr.

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-Occlusion or stenosis of a parent vessel or its distal branches is a major cause of poor patient outcome after cerebral aneurysm surgery. Despite great attempts to preserve patency at the time of clip application, intraoperative visual observation may not reveal arterial compromise or occlusion. Quantitative measurement of blood flow in cerebral vessels during aneurysm surgery can help prevent ischaemia and improve patient outcome. We report a case of a large complex middle cerebral artery (MCA) aneurysm in which perivascular microflow probes were used to measure blood flow quantitatively in MCA and its branches before and after aneurysm clipping. Following aneurysm clipping, blood flow in the MCA branches were significantly reduced to less than its initial baseline value with occlusion of the inferior M2 segment. Prompt detection of compromised blood flow gave the surgeon the opportunity to adjust the clip. This adjustment was performed several times until restore MCA flow to its preclipping values. Intraoperative quantitative vessel-flow measurements were safe and may have prevented cerebral ischaemia and neurological deficit to this patient.KEY WORDS: ultrasonic perivascular transit-time flow probe, aneurysm surgery, middle cerebral artery.Reajuste do clipe na cirurgia de aneurisma após avaliação do fluxo arterial por meio de microsonda ultrasônica perivascular: relato de caso RESUMO -A medida quantitativa do fluxo sanguíneo nos vasos cerebrais durante a cirurgia de aneurisma pode ajudar na prevenção de eventos isquêmicos e, portanto, melhorar os resultados. Relatamos o caso de paciente portador de aneurisma grande e complexo da bifurcação da artéria de cerebral média (ACM), no qual foram usadas micro-sondas ultrasônicas perivasculares para medir o fluxo de sangue quantitativamente na ACM e nos seus ramos antes e depois da clipagem do aneurisma. Após a clipagem do aneurisma, o fluxo de sangue diminuiu em todos os ramos, fazendo-se necessário o reajuste do clipe. Após vários ajustes na posição do clipe, o fluxo sanguíneo nos segmentos da ACM foi restabelecido. A descoberta imediata da alteração do fluxo de sangue proporcionou a oportunidade ao cirurgião de ajuste do clipe e conseqüente-mente o restabelecimento do fluxo a valores compatíveis àqueles antes da clipagem. O uso de micro-sondas ultrasônicas perivasculares para medida do fluxo sanguíneo durante a cirurgia de aneurisma pode prevenir eventos isquêmicos e eventualmente déficits neurológicos. PALAVRAS-CHAVE: micro-sonda ultrasônica perivascular, fluxo sanguíneo, aneurisma, artéria cerebral média.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clip readjustment in aneurysm surgery after flow evaluation using the ultrasonic perivascular probe: case report

Fagundes-Pereyra

Hoffman

Misra

et al. 2005

Arq. Neuro-Psiquiatr.

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“…Intraoperative angiography has been used in the surgical treatment of cerebral aneurysms in various series, including ours, consisting of 1073 aneurysms (Table 3). [1][2][3]6,7,9,11,16,17,19,21,22,28,32) Clip adjustment was performed in 13.8% of cases: residual aneurysms and arterial (Table 4). 5,8,14,15,17,23,25,27,31) The size and location of the aneurysm are correlated with the need to reposition the aneurysm clip after intraoperative angiography.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative angiography is useful in the treatment of cerebrovascular diseases. [1][2][3]6,7,9,11,[16][17][18][19]21,28,32,[34][35][36][37] However, the value of intraoperative angiography in the treatment of unruptured cerebral aneurysm is unknown. We have employed digital subtraction angiography during the intraoperative assessment of various cerebrovascular procedures including microsurgical clipping of cerebral aneurysms, resection of arteriovenous malformations, and cerebral revascularization.…”

Section: Introductionmentioning

confidence: 99%

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

Yanaka

Asakawa

Noguchi

et al. 2002

Neurol. Med. Chir.(Tokyo)

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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.

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Application of Microscope Integrated Indocyanine Green Video-Angiography During Microneurosurgical Treatment of Intracranial Aneurysms: A Review

Dashti

Laakso

Niemelä

et al. 2009

Acta Neurochirurgica Supplementum

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Indocyanine Green Video Angiography (ICG-VA) is recently introduced to the practice of cerebrovascular neurosurgery. This technique is safe and noninvasive and provides reliable real-time information on the patency of blood vessels of any size, as well as residual filling of aneurysms. In this article, a review of the literature and our experience with ICG-VA during microneurosurgery of intracranial aneurysms is presented.

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Optimal clip application and intraoperative angiography for intracranial aneurysms

Cited by 73 publications

References 14 publications

Clip readjustment in aneurysm surgery after flow evaluation using the ultrasonic perivascular probe: case report

Clip readjustment in aneurysm surgery after flow evaluation using the ultrasonic perivascular probe: case report

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

Application of Microscope Integrated Indocyanine Green Video-Angiography During Microneurosurgical Treatment of Intracranial Aneurysms: A Review

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