Image control after aneurysm clipping: Is 3D computed tomogram angiography enough?

Area of Science:

• Neurosurgery
• Vascular Imaging
• Radiology

Background:

• Cerebral digital subtraction angiography (DSA) is the gold standard for detecting aneurysm remnants post-clipping but is invasive and has limited availability.
• Computed tomography angiography (CTA) offers improved image quality and is a potential alternative to DSA.
• The study aims to compare the efficacy of CTA and DSA in identifying clinically significant postoperative aneurysm remnants.

Purpose of the Study:

• To compare the diagnostic accuracy of CTA versus DSA in detecting cerebral aneurysm remnants after surgical clipping.
• To evaluate the role of three-dimensional reconstructions of CTA in identifying residual aneurysms.

Main Methods:

• Retrospective analysis of patients who underwent surgical clipping for aneurysms and had postoperative CTA and DSA.
• Three-dimensional CTA reconstructions were compared with DSA findings.
• Variables such as clip number and prior treatments were analyzed for their impact on CTA accuracy.

Main Results:

• CTA demonstrated a sensitivity of 50% and a specificity of 97% for detecting aneurysm remnants.
• CTA missed remnants in complex cases, including previously embolized aneurysms or those requiring multiple clips.
• No CTA-undetected remnants required further aneurysm retreatment.

Conclusions:

• Three-dimensional CTA is highly effective in detecting clinically significant postoperative aneurysm remnants in uncomplicated cases.
• CTA may serve as a viable alternative to DSA, reducing the need for invasive procedures.
• Exclusion criteria for CTA's efficacy include complex aneurysms with prior embolization or extensive clipping.