Role of intraoperative angiography in the surgical treatment of cerebral aneurysms

1998 ◽  
Vol 88 (3) ◽  
pp. 441-447 ◽  
Author(s):  
Troy D. Payner ◽  
Terry G. Horner ◽  
Thomas J. Leipzig ◽  
John A. Scott ◽  
Richard L. Gilmor ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Parent Vessel ◽  
Intraoperative Angiography ◽  
Content Type ◽  
Aneurysm Clip ◽  
Giant Aneurysms ◽  
Vessel Stenosis ◽  
Distal Branch ◽  
Large And Giant Aneurysms ◽  
Fine Print

The benefit of using intraoperative angiography (IA) during aneurysm surgery is still uncertain. Object. In this prospective study, the authors evaluate the radiographically demonstrated success of surgical treatment in 151 consecutive patients harboring 173 aneurysms who selectively underwent IA examination. The authors also assess the frequency with which IA led to repositioning of the aneurysm clip. Methods. Intraoperative angiography was used selectively in this series, based on the surgeon's concern about the potential for residual aneurysm, distal branch occlusion, or parent vessel stenosis. Specific variables were analyzed to determine their impact on the incidence of clip repositioning and the accuracy of IA was evaluated by direct comparison with postoperative angiography (PA) in 90% of the cases in which IA was used. Conclusions. The selective use of IA led to successful treatment as shown by PA, with a low incidence of unexpected residual aneurysm (3.2%), distal branch occlusion (1.9%), and parent vessel stenosis (0%). Intraoperative angiography led to immediate repositioning of the aneurysm clip in 27% of the cases. Anterior cerebral artery aneurysms required clip repositioning less often and superior hypophyseal artery aneurysms required repositioning more often than aneurysms in other locations. Large and giant aneurysms required clip repositioning more often than small aneurysms; however, they were also more likely to display false success on IA as determined by PA. Aneurysms arising along the internal carotid artery were more likely to display successful clipping on IA, as determined by PA, than were aneurysms in other locations. The results of this series support the selective use of IA in the treatment of complex aneurysms, particularly large and giant aneurysms as well as superior hypophyseal artery aneurysms. As measured by PA, IA will improve the outcome of these patients.

Routine intraoperative angiography during aneurysm surgery

2002 ◽  
Vol 96 (6) ◽  
pp. 988-992 ◽  
Author(s):  
Veronica L. Chiang ◽  
Phillipe Gailloud ◽  
Kieran J. Murphy ◽  
Daniele Rigamonti ◽  
Rafael J. Tamargo
Keyword(s):  
Surgical Treatment ◽  
False Negative ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Intraoperative Angiography ◽  
Content Type ◽  
Negative Results ◽  
Parent Vessel Occlusion ◽  
Fine Print

Object. The routine use of intraoperative angiography as an aid in the surgical treatment of aneurysms is uncommon. The advantages of the ability to visualize residual aneurysm or unintended occlusion of parent vessels intraoperatively must be weighed against the complications associated with repeated angiography and prolonged vascular access. The authors reviewed the results of their routine use of intraoperative angiography to determine its safety and efficacy. Methods. Prospectively gathered data from all aneurysm cases treated surgically between January 1996 and June 2000 were reviewed. A total of 303 operations were performed in 284 patients with aneurysms; 24 patients also underwent postoperative angiography. Findings on intraoperative angiographic studies prompted reexploration and clip readjustment in 37 (11%) of the 337 aneurysms clipped. Angiography revealed parent vessel occlusion in 10 cases (3%), residual aneurysm in 22 cases (6.5%), and both residual lesion and parent vessel occlusion in five cases (1.5%). When compared with subsequent postoperative imaging, false-negative results were found on two intraoperative angiograms (8.3%) and a false-positive result was found on one (4.2%). Postoperative angiograms obtained in both false-negative cases revealed residual anterior communicating artery aneurysms. Both of these aneurysms also subsequently rebled, requiring reoperation. In the group that underwent intraoperative angiography, in 303 operations eight patients (2.6%) suffered complications, of which only one was neurological. Conclusions. In the surgical treatment of intracranial aneurysms, the use of routine intraoperative angiography is safe and helpful in a significant number of cases, although it does not replace careful intraoperative inspection of the surgical field.

Bilateral giant carotid-ophthalmic aneurysms

1975 ◽  
Vol 42 (5) ◽  
pp. 589-592 ◽  
Author(s):  
Francisco Garcia-Bengochea ◽  
Frank H. Deland
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Content Type ◽  
Giant Aneurysms ◽  
Unusual Combination ◽  
Fine Print

✓ The authors describe a patient with bilateral giant aneurysms of the internal carotid artery in the region of the ophthalmic artery. This case illustrates the feasibility of successful intracranial surgical treatment for this unusual combination.

Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy

2002 ◽  
Vol 96 (6) ◽  
pp. 993-999 ◽  
Author(s):  
Gordon Tang ◽  
C. Michael Cawley ◽  
Jacques E. Dion ◽  
Daniel L. Barrow
Keyword(s):  
Surgical Treatment ◽  
Multivariate Logistic Regression Model ◽  
Complication Rates ◽  
Aneurysm Surgery ◽  
Intraoperative Angiography ◽  
Content Type ◽  
Aneurysm Size ◽  
Proximal Internal Carotid Artery ◽  
Large Aneurysm ◽  
Fine Print

Object. Indications for intraoperative angiography during aneurysm surgery remain unclear. To define its use, the authors report the results of a prospective study in which this modality was used in all patients undergoing surgery for intracranial aneurysms. Methods. Intraoperative angiography was performed prospectively in the surgical treatment of 517 consecutive aneurysms regardless of the lesion's location, size, or complexity. In 64 (12.4%) of 517 aneurysms intraoperative angiography findings prompted a change in surgical treatment. Residual aneurysm (47%) was the most frequent finding leading to clip revision. In 44% of cases, intraoperative angiography revealed vessel compromise. Surgery for aneurysms of the proximal internal carotid artery (ICA) was the most frequently altered, with lesions located at the superior hypophyseal artery (SHA) and clinoidal region having the highest revision rates, eight (40%) of 20 and eight (44%) of 18, respectively. Aneurysm size predicted the need for revision; giant aneurysms (> 24 mm) underwent revision in nine (29%) of 31 cases, whereas large aneurysms (15–24 mm) were revised in 12 (22%) of 54 cases. In a multivariate logistic regression model, factors related to increased revision rates included the SHA and clinoidal locations, as well as giant and large size. Ninety-five patients underwent both intraoperative and postoperative angiography. Five discrepancies were noted (95% accuracy); four were flow-related and one involved a previously unrecognized residual aneurysm. Complications attributable to intraoperative angiography occurred in 0.4% of cases. Conclusions. Proximal ICA location and large aneurysm size significantly predicted revision of surgery following intraoperative angiography. Unexpected findings, even in less complex locations, are frequently identified on intraoperative angiography. Low complication rates, high accuracy, and the unexpected need for clip readjustments favor a more widespread use of intraoperative angiography.

Surgical treatment of cerebral metastases from lung cancer

1971 ◽  
Vol 35 (4) ◽  
pp. 416-420 ◽  
Author(s):  
Edwin E. MacGee
Keyword(s):  
Lung Cancer ◽  
Surgical Treatment ◽  
Operative Mortality ◽  
Cerebral Metastases ◽  
Cerebral Metastasis ◽  
Metastatic Lung Cancer ◽  
Content Type ◽  
Intracranial Surgery ◽  
Metastatic Lung ◽  
Fine Print

✓ Results in 27 cases of intracranial surgery for metastatic lung cancer are evaluated with regard to both the quality and duration of survival; 56% of the patients lived more than 1 year, with the longest survivor still living 32 months after operation. The operative mortality was 26%. These data suggest that intracranial surgery is worthwhile in patients with lung cancer when the cerebral metastasis is either solitary or single.

Characteristics and use of ultra-long aneurysm clips

1984 ◽  
Vol 60 (1) ◽  
pp. 145-150 ◽  
Author(s):  
Kenichiro Sugita ◽  
Shigeaki Kobayashi ◽  
Toshiki Inoue ◽  
Toshiki Takemae
Keyword(s):  
Content Type ◽  
Giant Aneurysms ◽  
Vertebrobasilar Artery ◽  
Fine Print

✓ Ultra-long aneurysm clips, 21 to 40 mm in length, are described, and their characteristics and application delineated. These clips have been used in 30 procedures for various kinds of aneurysms. They are useful not only for wide-necked and giant aneurysms but also for deeply located aneurysms such as those on the vertebrobasilar artery.

Intraoperative angiography in the resection of arteriovenous malformations

1994 ◽  
Vol 80 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Shigetaka Anegawa ◽  
Takashi Hayashi ◽  
Ryuichiro Torigoe ◽  
Katsuhiko Harada ◽  
Shun-ichi Kihara
Keyword(s):  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Three Dimensional ◽  
Initial Operation ◽  
Total Resection ◽  
Intraoperative Angiography ◽  
Content Type ◽  
Fine Print

✓ Surgical resection of 13 operatively obscure arteriovenous malformations (AVM's) was accomplished with the assistance of intraoperative angiography, which was performed stereographically to provide three-dimensional orientation and was repeated until total resection of the AVM was confirmed. All films obtained were subtracted to improve clarity. The method presented here may be useful for the resection of all types of AVM. Only two patients had residual AVM after the initial operation. No complications attributable to angiography were noted.

Crouzon's disease (craniofacial dysostosis)

1972 ◽  
Vol 37 (4) ◽  
pp. 434-441 ◽  
Author(s):  
Jack Kushner ◽  
Eben Alexander ◽  
Courtland H. Davis ◽  
David L. Kelly ◽  
Annetta Horwitz Kushner
Keyword(s):  
Surgical Treatment ◽  
Original Description ◽  
Content Type ◽  
Craniofacial Dysostosis ◽  
Fine Print

✓ This article discusses the nature and treatment of Crouzon's disease and reproduces a translation of part of Crouzon's original description. Six typical patients with this disease are presented, and the reasons for surgical treatment emphasized.

Delayed breaking of a Heifetz aneurysm clip

1977 ◽  
Vol 47 (3) ◽  
pp. 463-465 ◽  
Author(s):  
Antti Servo ◽  
Matti Puranen
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Left Middle Cerebral Artery ◽  
Carotid Angiography ◽  
Content Type ◽  
Aneurysm Clip ◽  
Correct Placement ◽  
Left Middle ◽  
Fine Print

✓ An aneurysm of the left middle cerebral artery was treated by clipping with a Heifetz clip. The correct placement was confirmed angiographically immediately after the operation. At carotid angiography 1 year later the clip was found to have broken, and the aneurysm had increased in size.

Surgery for Parkinson disease in the United States, 1996 to 2000: practice patterns, short-term outcomes, and hospital charges in a nationwide sample

2003 ◽  
Vol 99 (5) ◽  
pp. 863-871 ◽  
Author(s):  
Emad N. Eskandar ◽  
Alice Flaherty ◽  
G. Rees Cosgrove ◽  
Leslie A. Shinobu ◽  
Fred G. Barker
Keyword(s):  
Surgical Treatment ◽  
Parkinson Disease ◽  
Practice Patterns ◽  
The United States ◽  
Hospital Charges ◽  
Short Term ◽  
Content Type ◽  
The Us ◽  
Fine Print ◽  
Deep Brain

Object. The surgical treatment of Parkinson disease (PD) has undergone a dramatic shift, from stereotactic ablative procedures toward deep brain stimulaion (DBS). The authors studied this process by investigating practice patterns, mortality and morbidity rates, and hospital charges as reflected in the records of a representative sample of US hospitals between 1996 and 2000. Methods. The authors conducted a retrospective cohort study by using the Nationwide Inpatient Sample database; 1761 operations at 71 hospitals were studied. Projected to the US population, there were 1650 inpatient procedures performed for PD per year (pallidotomies, thalamotomies, and DBS), with no significant change in the annual number of procedures during the study period. The in-hospital mortality rate was 0.2%, discharge other than to home was 8.1%, and the rate of neurological complications was 1.8%, with no significant differences between procedures. In multivariate analyses, hospitals with larger annual caseloads had lower mortality rates (p = 0.002) and better outcomes at hospital discharge (p = 0.007). Placement of deep brain stimulators comprised 0% of operations in 1996 and 88% in 2000. Factors predicting placement of these devices in analyses adjusted for year of surgery included younger age, Caucasian race, private insurance, residence in higher-income areas, hospital teaching status, and smaller annual hospital caseload. In multivariate analysis, total hospital charges were 2.2 times higher for DBS (median $36,000 compared with $12,000, p < 0.001), whereas charges were lower at higher-volume hospitals (p < 0.001). Conclusions. Surgical treatment of PD in the US changed significantly between 1996 and 2000. Larger-volume hospitals had superior short-term outcomes and lower charges. Future studies should address long-term functional end points, cost/benefit comparisons, and inequities in access to care.

Distal anterior inferior cerebellar artery aneurysms

2002 ◽  
Vol 97 (3) ◽  
pp. 692-696 ◽  
Author(s):  
Eric L. Zager ◽  
Ellen G. Shaver ◽  
Robert W. Hurst ◽  
Eugene S. Flamm
Keyword(s):  
Artery Aneurysm ◽  
Distal Segment ◽  
Anterior Inferior Cerebellar Artery ◽  
Management Options ◽  
Content Type ◽  
Von Hippel Lindau ◽  
Cerebellar Artery ◽  
Distal Branch ◽  
Acute Subarachnoid Hemorrhage ◽  
Fine Print

✓ Aneurysms of the distal anterior inferior cerebellar artery (AICA) are rare; fewer than 100 cases have been reported. The authors detail their experience with four cases and present endovascular as well as microsurgical management options. The medical records and neuroimaging studies obtained in four patients who were treated at a single institution were reviewed. Clinical presentations, neuroimaging and intraoperative findings, and clinical outcomes were analyzed. There were three men and one woman; their mean age was 43 years. Two patients presented with acute subarachnoid hemorrhage (SAH), and two presented with ataxia and vertigo (one with tinnitus, the other with hearing loss). Angiographic studies demonstrated aneurysms of the distal segment of the AICA. In one patient with von Hippel—Lindau syndrome and multiple cerebellar hemangioblastomas, a feeding artery aneurysm was found on a distal branch of the AICA. Three of the patients underwent successful surgical obliteration of their aneurysms, one by clipping, one by trapping, and one by resection along with the tumor. The fourth patient underwent coil embolization of the distal AICA and the aneurysm. All patients made an excellent neurological recovery. Patients with aneurysms in this location may present with typical features of an acute SAH or with symptoms referable to the cerebellopontine angle. Evaluation with computerized tomography, magnetic resonance (MR) imaging, MR angiography, and digital subtraction angiography should be performed. For lesions distal to branches coursing to the brainstem, trapping and aneurysm resection are viable options that do not require bypass. Endovascular obliteration is also a reasonable option, although the possibility of retrograde thrombosis of the AICA is a concern.

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