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Related Experiment Videos

MR imaging after surgery for vertebrobasilar aneurysm.

M F Brothers1, A J Fox, D H Lee

  • 1Department of Diagnostic Radiology, University Hospital, University of Western Ontario, London, Canada.

AJNR. American Journal of Neuroradiology
|January 1, 1990
PubMed
Summary

High-field magnetic resonance (MR) imaging is safe for evaluating cerebral aneurysm surgery, outperforming CT in detecting postoperative ischemia. However, MR is not accurate for assessing residual aneurysm lumens.

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Area of Science:

  • Neurosurgery
  • Neuroradiology
  • Medical Imaging

Background:

  • Cerebral aneurysms, particularly in the vertebrobasilar system, pose significant surgical challenges.
  • Postoperative assessment is crucial for monitoring treatment efficacy and detecting complications.
  • Computed tomography (CT) can be limited by artifacts in evaluating patients with surgical clips.

Purpose of the Study:

  • To evaluate the safety and diagnostic utility of high-field magnetic resonance (MR) imaging in the postoperative assessment of patients who underwent surgery for cerebral aneurysms.
  • To compare the performance of MR imaging with CT in detecting postoperative complications, specifically ischemic lesions.

Main Methods:

  • Retrospective analysis of 21 high-field (1.5 T) MR scans from 18 patients treated for vertebrobasilar system aneurysms.

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  • Surgical interventions included nonmagnetic Sugita clips (17 patients) and a Drake tourniquet (1 patient).
  • Comparison of MR findings with postoperative CT scans and angiography where available.

    • Main Results:

    • High-field MR imaging was safely performed in the early postoperative period (mean 7.2 days) without adverse events.
    • MR demonstrated significantly less artifact compared to CT, improving visualization of surgical sites.
    • MR identified postoperative ischemic lesions in 15 patients, primarily small brainstem foci, which were largely missed by CT (over 80% missed).
    • While MR could partially image aneurysms, it was inaccurate in assessing residual lumens, with angiography revealing missed residual lumens in 4 of 9 thrombosed-appearing aneurysms.

    Conclusions:

    • High-field MR imaging is a safe and superior modality to CT for postoperative assessment of cerebral aneurysm surgery, especially for detecting ischemic complications.
    • Nonmagnetic surgical clips are essential for safe MR imaging in this patient population.
    • MR imaging's limitations in assessing residual aneurysm lumens necessitate complementary imaging modalities like angiography.