Angiography after aneurysm surgery: indications for "selective" angiography

Area of Science:

• Neurosurgery
• Cerebrovascular Surgery
• Interventional Neuroradiology

Background:

• Postoperative cerebral angiography is often a surgeon's preference for confirming clip placement after aneurysm surgery.
• Rising healthcare costs and resource limitations necessitate re-evaluation of routine diagnostic practices.

Purpose of the Study:

• To identify specific aneurysm characteristics or locations associated with a higher risk of incomplete or inaccurate surgical clipping.
• To determine if routine postoperative angiography can be selectively applied based on aneurysm features.

Main Methods:

• A retrospective analysis of 312 intracerebral aneurysms in 227 patients treated by a single surgeon.
• Evaluation of factors including aneurysmal size, patient demographics, and preoperative grading (Hunt/Hess, Fisher CT).
• Correlation of these factors with surgical outcomes: residual aneurysm or major vessel occlusion.

Main Results:

• 13 cases (4.2%) of residual aneurysm and 1 case (0.3%) of major vessel occlusion were identified.
• Aneurysms in deep midline locations (posterior circulation, anterior communicating artery) and ophthalmic artery regions showed a significantly higher rate of imperfect clip placement (8.2%) compared to other locations (0.6%).
• Incompletely obliterated aneurysms demonstrated a high rate of rehemorrhage.

Conclusions:

• Deep midline aneurysms are identified as a high-risk group for inadequate clipping, mandating confirmatory postoperative evaluation.
• These findings provide a basis for comparing outcomes with intraoperative angiography and refining postoperative imaging protocols.