MR imaging after surgery for vertebrobasilar aneurysm

We examined the safety and utility of high-field MR in patients who had surgery for cerebral aneurysms of the vertebrobasilar system. Eighteen posterior (and three coincidental anterior) circulation aneurysms were treated. Twenty-one MR scans were obtained at a mean postoperative interval of 7.2 days. The mean size of the preoperative vertebrobasilar aneurysm was 2.2 cm; six were giant (greater than 2.5 cm) and eight were large (greater than 1.5, less than or equal to 2.5 cm). In 17 patients, Sugita nonmagnetic clips were used. In one other, a Drake tourniquet was used. No ill effects occurred from scanning with a high-field imaging unit at 1.5 T. The MR clip artifact was much less obtrusive than that on CT. In 11 cases, the aneurysm could be partially imaged postoperatively, mainly in very large aneurysms or in those treated by clipping the parent vessel. Of these, two revealed residual lumina on MR and nine looked completely thrombosed. Postoperative angiography showed that in four of the thrombosed-appearing aneurysms a residual lumen with a mean diameter of 1.0 cm had been missed. In the patient imaged after application of a Drake tourniquet, no artifact was seen, and a good assessment of progressive partial thrombosis was obtained. Evolution of the signal intensity of new aneurysm thrombus, in those minimally or not obscured by artifact, coincides with patterns previously described for hemoglobin in intracerebral hematomas. The earliest hyperintensity could be seen in either the periphery or the center of the new thrombus. All 15 patients examined with new postoperative deficits showed appropriate lesions, mainly small brainstem ischemic foci. Postoperative CT (performed in all but four of these patients) missed over 80% of these lesions, mainly owing to artifact from clip or bone. We conclude that MR is better than CT in the postoperative assessment of aneurysm patients, particularly in demonstrating small zones of ischemia. High-field MR scanning is safe if nonmagnetic surgical clips are used. MR is not accurate in assessing residual lumina.