Role of intraoperative angiography in the surgical treatment of cerebral aneurysms

Troy D. Payner, Terry G. Horner, Thomas J. Leipzig, John A. Scott, Richard L. Gilmor, Andrew J. DeNardo

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

The benefit of using intraoperative angiography (IA) during aneurysm surgery is still uncertain. Object. In this prospective study, the authors evaluate the radiographically demonstrated success of surgical treatment in 151 consecutive patients harboring 173 aneurysms who selectively underwent IA examination. The authors also assess the frequency with which IA led to repositioning of the aneurysm clip. Methods. Intraoperative angiography was used selectively in this series, based on the surgeon's concern about the potential for residual aneurysm, distal branch occlusion, or parent vessel stenosis. Specific variables were analyzed to determine their impact on the incidence of clip repositioning and the accuracy of IA was evaluated by direct comparison with postoperative angiography (PA) in 90% of the cases in which IA was used. Conclusions. The selective use of IA led to successful treatment as shown by PA, with a low incidence of unexpected residual aneurysm (3.2%), distal branch occlusion (1.9%), and parent vessel stenosis (0%). Intraoperative angiography led to immediate repositioning of the aneurysm clip in 27% of the cases. Anterior cerebral artery aneurysms required clip repositioning less often and superior hypophyseal artery aneurysms required repositioning more often than aneurysms in other locations. Large and giant aneurysms required clip repositioning more often than small aneurysms; however, they were also more likely to display false success on IA as determined by PA. Aneurysms arising along the internal carotid artery were more likely to display successful clipping on IA, as determined by PA, than were aneurysms in other locations. The results of this series support the selective use of IA in the treatment of complex aneurysms, particularly large and giant aneurysms as well as superior hypophyseal artery aneurysms. As measured by PA, IA will improve the outcome of these patients.

Original languageEnglish (US)
Pages (from-to)441-448
Number of pages8
JournalJournal of Neurosurgery
Volume88
Issue number3
StatePublished - Mar 1998
Externally publishedYes

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Intracranial Aneurysm
Angiography
Aneurysm
Surgical Instruments
Therapeutics
Pathologic Constriction
Arteries
Incidence
Internal Carotid Artery

Keywords

  • Cerebral aneurysm
  • Digital subtraction angiography
  • Distal branch occlusion
  • Intraoperative angiography
  • Postoperative angiography
  • Residual aneurysm

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Payner, T. D., Horner, T. G., Leipzig, T. J., Scott, J. A., Gilmor, R. L., & DeNardo, A. J. (1998). Role of intraoperative angiography in the surgical treatment of cerebral aneurysms. Journal of Neurosurgery, 88(3), 441-448.

Role of intraoperative angiography in the surgical treatment of cerebral aneurysms. / Payner, Troy D.; Horner, Terry G.; Leipzig, Thomas J.; Scott, John A.; Gilmor, Richard L.; DeNardo, Andrew J.

In: Journal of Neurosurgery, Vol. 88, No. 3, 03.1998, p. 441-448.

Research output: Contribution to journalArticle

Payner, TD, Horner, TG, Leipzig, TJ, Scott, JA, Gilmor, RL & DeNardo, AJ 1998, 'Role of intraoperative angiography in the surgical treatment of cerebral aneurysms', Journal of Neurosurgery, vol. 88, no. 3, pp. 441-448.
Payner TD, Horner TG, Leipzig TJ, Scott JA, Gilmor RL, DeNardo AJ. Role of intraoperative angiography in the surgical treatment of cerebral aneurysms. Journal of Neurosurgery. 1998 Mar;88(3):441-448.
Payner, Troy D. ; Horner, Terry G. ; Leipzig, Thomas J. ; Scott, John A. ; Gilmor, Richard L. ; DeNardo, Andrew J. / Role of intraoperative angiography in the surgical treatment of cerebral aneurysms. In: Journal of Neurosurgery. 1998 ; Vol. 88, No. 3. pp. 441-448.
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abstract = "The benefit of using intraoperative angiography (IA) during aneurysm surgery is still uncertain. Object. In this prospective study, the authors evaluate the radiographically demonstrated success of surgical treatment in 151 consecutive patients harboring 173 aneurysms who selectively underwent IA examination. The authors also assess the frequency with which IA led to repositioning of the aneurysm clip. Methods. Intraoperative angiography was used selectively in this series, based on the surgeon's concern about the potential for residual aneurysm, distal branch occlusion, or parent vessel stenosis. Specific variables were analyzed to determine their impact on the incidence of clip repositioning and the accuracy of IA was evaluated by direct comparison with postoperative angiography (PA) in 90{\%} of the cases in which IA was used. Conclusions. The selective use of IA led to successful treatment as shown by PA, with a low incidence of unexpected residual aneurysm (3.2{\%}), distal branch occlusion (1.9{\%}), and parent vessel stenosis (0{\%}). Intraoperative angiography led to immediate repositioning of the aneurysm clip in 27{\%} of the cases. Anterior cerebral artery aneurysms required clip repositioning less often and superior hypophyseal artery aneurysms required repositioning more often than aneurysms in other locations. Large and giant aneurysms required clip repositioning more often than small aneurysms; however, they were also more likely to display false success on IA as determined by PA. Aneurysms arising along the internal carotid artery were more likely to display successful clipping on IA, as determined by PA, than were aneurysms in other locations. The results of this series support the selective use of IA in the treatment of complex aneurysms, particularly large and giant aneurysms as well as superior hypophyseal artery aneurysms. As measured by PA, IA will improve the outcome of these patients.",
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AU - Horner, Terry G.

AU - Leipzig, Thomas J.

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AU - DeNardo, Andrew J.

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N2 - The benefit of using intraoperative angiography (IA) during aneurysm surgery is still uncertain. Object. In this prospective study, the authors evaluate the radiographically demonstrated success of surgical treatment in 151 consecutive patients harboring 173 aneurysms who selectively underwent IA examination. The authors also assess the frequency with which IA led to repositioning of the aneurysm clip. Methods. Intraoperative angiography was used selectively in this series, based on the surgeon's concern about the potential for residual aneurysm, distal branch occlusion, or parent vessel stenosis. Specific variables were analyzed to determine their impact on the incidence of clip repositioning and the accuracy of IA was evaluated by direct comparison with postoperative angiography (PA) in 90% of the cases in which IA was used. Conclusions. The selective use of IA led to successful treatment as shown by PA, with a low incidence of unexpected residual aneurysm (3.2%), distal branch occlusion (1.9%), and parent vessel stenosis (0%). Intraoperative angiography led to immediate repositioning of the aneurysm clip in 27% of the cases. Anterior cerebral artery aneurysms required clip repositioning less often and superior hypophyseal artery aneurysms required repositioning more often than aneurysms in other locations. Large and giant aneurysms required clip repositioning more often than small aneurysms; however, they were also more likely to display false success on IA as determined by PA. Aneurysms arising along the internal carotid artery were more likely to display successful clipping on IA, as determined by PA, than were aneurysms in other locations. The results of this series support the selective use of IA in the treatment of complex aneurysms, particularly large and giant aneurysms as well as superior hypophyseal artery aneurysms. As measured by PA, IA will improve the outcome of these patients.

AB - The benefit of using intraoperative angiography (IA) during aneurysm surgery is still uncertain. Object. In this prospective study, the authors evaluate the radiographically demonstrated success of surgical treatment in 151 consecutive patients harboring 173 aneurysms who selectively underwent IA examination. The authors also assess the frequency with which IA led to repositioning of the aneurysm clip. Methods. Intraoperative angiography was used selectively in this series, based on the surgeon's concern about the potential for residual aneurysm, distal branch occlusion, or parent vessel stenosis. Specific variables were analyzed to determine their impact on the incidence of clip repositioning and the accuracy of IA was evaluated by direct comparison with postoperative angiography (PA) in 90% of the cases in which IA was used. Conclusions. The selective use of IA led to successful treatment as shown by PA, with a low incidence of unexpected residual aneurysm (3.2%), distal branch occlusion (1.9%), and parent vessel stenosis (0%). Intraoperative angiography led to immediate repositioning of the aneurysm clip in 27% of the cases. Anterior cerebral artery aneurysms required clip repositioning less often and superior hypophyseal artery aneurysms required repositioning more often than aneurysms in other locations. Large and giant aneurysms required clip repositioning more often than small aneurysms; however, they were also more likely to display false success on IA as determined by PA. Aneurysms arising along the internal carotid artery were more likely to display successful clipping on IA, as determined by PA, than were aneurysms in other locations. The results of this series support the selective use of IA in the treatment of complex aneurysms, particularly large and giant aneurysms as well as superior hypophyseal artery aneurysms. As measured by PA, IA will improve the outcome of these patients.

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KW - Digital subtraction angiography

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