Intraoperative computed tomographic angiography in cerebral aneurysm surgery: a pilot feasibility study

Area of Science:

• Neurosurgery
• Vascular Imaging
• Radiology

Background:

• Cerebral aneurysms pose a significant risk of rupture and hemorrhage.
• Surgical clipping is a common treatment, but complete obliteration and avoidance of major artery occlusion are critical.
• Intraoperative assessment of surgical success is essential to prevent complications.

Purpose of the Study:

• To evaluate the feasibility and utility of intraoperative computed tomographic angiography (iCTA).
• To assess iCTA's ability to detect residual aneurysms after clipping.
• To determine if iCTA can identify major cerebral artery occlusion during surgery.

Main Methods:

• Prospective study of 6 patients with ruptured anterior circulation aneurysms undergoing craniotomy and clipping.
• iCTA performed post-clipping to check for aneurysm remnants and major artery occlusion.
• Comparison of iCTA findings with immediate postoperative digital subtraction angiography (DSA).

Main Results:

• One residual aneurysm was detected by iCTA and confirmed by postoperative DSA.
• No major arterial occlusions were identified by iCTA or postoperative DSA.
• iCTA demonstrated feasibility in the intraoperative setting.

Conclusions:

• iCTA is a feasible and potentially useful tool for identifying residual aneurysms after surgical clipping.
• iCTA can help detect major cerebral artery occlusion, although none were found in this series.
• Intraoperative imaging can enhance the safety and efficacy of aneurysm surgery.