Routine intraoperative angiography during aneurysm surgery

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.

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Percutaneous intracranial stent placement for aneurysms

Journal of Neurosurgery ◽

10.3171/jns.2003.99.1.0023 ◽

2003 ◽

Vol 99 (1) ◽

pp. 23-30 ◽

Cited By ~ 61

Author(s):

Patrick P. Han ◽

Felipe C. Albuquerque ◽

Francisco A. Ponce ◽

Christopher I. Mackay ◽

Joseph M. Zabramski ◽

...

Keyword(s):

Stent Placement ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Parent Vessel ◽

Vessel Occlusion ◽

Content Type ◽

Intracranial Stent ◽

Parent Vessel Occlusion ◽

Vertebrobasilar Junction ◽

Fine Print

Object. Intracranial stent placement combined with coil embolization is an emerging procedure for the treatment of intracranial aneurysms. The authors report their results using intracranial stents for the treatment of intracranial aneurysms. Methods. A prospectively maintained database was reviewed to identify all patients with intracranial aneurysms that were treated with intracranial stents. Ten lesions, including eight broad-based aneurysms and two dissecting aneurysms, were treated in 10 patients. Four lesions were located in the cavernous segment of the internal carotid artery, two at the vertebrobasilar junction, two at the basilar trunk, one at the basilar apex, and one in the intracranial vertebral artery. Attempts were made to place stents in 13 patients, but in three the stents could not be delivered. Altogether, intracranial stents were placed in 10 patients for 10 lesions. Results that were determined to be satisfactory angiographically were achieved in all 10 lesions. Two patients suffered permanent neurological deterioration related to stent placement. In two patients, the aneurysm recurred after stent-assisted coil embolization. In one case of recurrence a second attempt at coil embolization was successful, whereas in the second case of recurrence parent vessel occlusion was required and well tolerated. Conclusions. Intracranial stents can be a useful addition to coil embolization by providing mechanical, hemodynamic, and visual benefits in the treatment of complex, broad-based aneurysms.

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Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization

Journal of Neurosurgery ◽

10.3171/jns.1995.83.5.0843 ◽

1995 ◽

Vol 83 (5) ◽

pp. 843-853 ◽

Cited By ~ 139

Author(s):

John H. Gurian ◽

Neil A. Martin ◽

Wesley A. King ◽

Gary R. Duckwiler ◽

Guido Guglielmi ◽

...

Keyword(s):

Surgical Treatment ◽

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Parent Vessel ◽

Vessel Occlusion ◽

Content Type ◽

Neurological Improvement ◽

Parent Vessel Occlusion ◽

Group B

✓ Modern endovascular techniques permit treatment of intracranial aneurysms in many circumstances when surgery is associated with significant morbidity. Occasionally, embolization of aneurysms is unsuccessful or incomplete or followed by complications, in which case surgical management is required. Since 1986, 196 patients have undergone embolization of intracranial aneurysms at the authors' institution and 21 (11%) required subsequent surgical treatment. Attempted embolization failed in five patients (Group A). Ten patients (Group B) had only partial occlusion of the aneurysm or demonstrated recanalization on follow-up studies. Eight of these Group B patients underwent embolization with Guglielmi detachable coils (GDCs), representing 5.7% of the 141 GDC-treated patients in this experience. Surgical treatment in these two groups consisted of clipping (eight cases), surgical parent vessel occlusion (one case), and parent vessel occlusion with extracranial—intracranial bypass (six cases). Fourteen (93%) of the 15 patients in these two groups had an excellent or good outcome with complete aneurysm occlusion. Six patients underwent surgery to treat complications related to the endovascular procedure (Group C). Of these, four patients had neurological improvement compared to their preoperative state, and two died. This series of cases demonstrates that surgical treatment of aneurysms is usually possible with good results following incomplete embolization and emphasizes the need for close and continued neurosurgical involvement in the endovascular management of intracranial aneurysms.

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Role of intraoperative angiography in the surgical treatment of cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1998.88.3.0441 ◽

1998 ◽

Vol 88 (3) ◽

pp. 441-447 ◽

Cited By ~ 67

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.

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Treatment and Outcome of Anterior Inferior Cerebellar Artery (AICA) Aneurysms: Helsinki Series of 15 Consecutive Patients.

10.21203/rs.3.rs-477788/v1 ◽

2021 ◽

Author(s):

Sajjad Muhammad ◽

Ahmad Hafez ◽

Hanna Kaukovalta ◽

Behnam Jahromi ◽

Riku Kivisaari ◽

...

Keyword(s):

Surgical Treatment ◽

Clinical Outcome ◽

High Rate ◽

Anterior Inferior Cerebellar Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Cerebellar Artery ◽

Parent Vessel Occlusion ◽

Good Grade ◽

Anterior Petrosectomy

Abstract Background: Anterior inferior cerebellar artery (AICA) aneurysms are rare posterior circulation lesions that are challenging to treat.Objectives: To present the treatment and clinical outcome of AICA aneurysms in an unselected cohort of patients.Methods: A retrospective analysis of patient record files, DSA and CT angiography images of 15 consecutive patients harboring AICA aneurysms treated between 1968 to 2017. Results: Eighty percent of the AICA aneurysm patients were females. Twenty percent presented with intracerebral hemorrhage (ICH) and 40% had intraventricular hemorrhage. Eleven (73%) patients suffered from subarachnoid hemorrhage (SAH); a good-grade SAH (Hunt and Hess grade 1-3) was observed in 82 % SAH patients. Surgery was performed in 73 % patients. Coil embolization was done in 7% patients and 20 % patients were treated conservatively. In 73 % patients retrosigmoid approach was used and in 27 % patients a sub-temporal approach with anterior petrosectomy was applied. A parent vessel occlusion was needed to occlude the aneurysm in 18 % patients.Conclusion: Surgical treatment of AICA aneurysms has a high rate of cranial nerve deficits but most of patients have a good long-term clinical outcome. Surgical treatment may be an option only in selected cases of AICA aneurysms.

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Preservation of the olfactory tract in bifrontal craniotomy for anterior communicating artery aneurysms, and the functional prognosis

Journal of Neurosurgery ◽

10.3171/jns.1981.54.3.0342 ◽

1981 ◽

Vol 54 (3) ◽

pp. 342-345 ◽

Cited By ~ 60

Author(s):

Jiro Suzuki ◽

Takashi Yoshimoto ◽

Kazuo Mizoi

Keyword(s):

Surgical Treatment ◽

Anterior Communicating Artery ◽

Content Type ◽

Olfactory Tract ◽

Anterior Communicating Artery Aneurysms ◽

Tract Damage ◽

Fine Print

✓ Results of surgical treatment of anterior communicating artery aneurysms, approached via bifrontal craniotomy, are reported in 110 cases. It was possible to preserve the olfactory tracts bilaterally or unilaterally in over 65% of these cases: 47% with bilateral preservation and 34% with unilateral preservation; 33% of the patients with bilateral olfactory tract damage reported subjectively normal olfaction. Objective examination of olfaction by an otolaryngologist showed that 84% of the patients reporting normal olfaction did indeed have normal olfaction, whereas 91% of these reporting no olfaction were anosmic.

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Postoperative paraplegia with preserved intraoperative somatosensory evoked potentials

Journal of Neurosurgery ◽

10.3171/jns.1985.63.2.0296 ◽

1985 ◽

Vol 63 (2) ◽

pp. 296-300 ◽

Cited By ~ 212

Author(s):

Howard H. Ginsburg ◽

Andrew G. Shetter ◽

Peter A. Raudzens

Keyword(s):

Evoked Potentials ◽

Somatosensory Evoked Potentials ◽

Spinal Surgery ◽

False Negative ◽

Neurological Function ◽

Content Type ◽

Negative Results ◽

False Negative Results ◽

Fine Print ◽

Achondroplastic Dwarf

✓ Intraoperative somatosensory evoked potentials (SSEP's) are being used with increasing frequency to monitor neurological function during spinal surgery. The authors report a case of postoperative paraplegia that occurred despite preserved intraoperative SSEP's in an achondroplastic dwarf who underwent correction of a congenital kyphoscoliosis. Surgeons and anesthesiologists involved with SSEP monitoring should be aware that false-negative results may occur with this technique.

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Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy

Journal of Neurosurgery ◽

10.3171/jns.2002.96.6.0993 ◽

2002 ◽

Vol 96 (6) ◽

pp. 993-999 ◽

Cited By ~ 142

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.

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Spontaneous thrombosis of posterior cerebral artery aneurysm with angiographic reappearance

Journal of Neurosurgery ◽

10.3171/jns.1993.79.3.0434 ◽

1993 ◽

Vol 79 (3) ◽

pp. 434-437 ◽

Cited By ~ 26

Author(s):

John L. D. Atkinson ◽

John I. Lane ◽

Harold J. Colbassani ◽

D. Mark E. Llewellyn

Keyword(s):

Mr Imaging ◽

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Brain Infarction ◽

Artery Aneurysm ◽

Parent Vessel ◽

Spontaneous Thrombosis ◽

Vessel Occlusion ◽

Content Type ◽

Parent Vessel Occlusion

✓ The case is presented of a 23-year-old man suffering ischemic brain infarction from spontaneous thrombosis of a left posterior cerebral artery P1–P2 junction aneurysm. Vasospasm and/or partial parent vessel occlusion were documented by magnetic resonance (MR) imaging and angiography. Repeat cerebral angiography and MR imaging 3 months later revealed patency of the posterior cerebral artery and luminal filling of a 1-cm fusiform aneurysm, which was successfully trapped at surgery.

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Bleeding risk of cerebral vascular malformations in hereditary hemorrhagic telangiectasia

Journal of Neurosurgery ◽

10.3171/jns.2000.92.5.0779 ◽

2000 ◽

Vol 92 (5) ◽

pp. 779-784 ◽

Cited By ~ 101

Author(s):

Ronald B. Willemse ◽

Johannes J. Mager ◽

Cornelius J. J. Westermann ◽

Timotheus T. C. Overtoom ◽

Henk Mauser ◽

...

Keyword(s):

Hereditary Hemorrhagic Telangiectasia ◽

Vascular Malformations ◽

False Negative ◽

Venous Drainage ◽

Bleeding Risk ◽

Low Grade ◽

Content Type ◽

Risk Of Bleeding ◽

Negative Results ◽

Fine Print

Object. Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal-dominant vascular dysplasia with a high prevalence of cerebrovascular malformations (CVMs), mostly manifested as arteriovenous malformations (AVMs). The natural history and bleeding risk of these CVMs is unknown. The authors investigated the risk of bleeding in conjunction with clinical and radiological features in patients with HHT and proven CVMs.Methods. Intravenous digital subtraction (DS) angiography was used to screen 196 patients with HHT for the presence of CVMs. Patients with abnormal results on DS angiography were asked to undergo a conventional cerebral angiographic study. All patients with a proven CVM were assessed by a neurologist. The bleeding risk was retrospectively and prospectively calculated for patients with AVMs only, as well as for the whole cohort of patients with CVMs.Twenty-four patients (12.2%; 16 female and eight male), aged 14 to 66 years (mean 35.4 years) with one or more CVMs were identified. Fifteen patients (62.5%) had a CVM and a pulmonary AVM. Eleven patients (45.8%) exhibited no neurological signs of their CVM; six (25%) had headache or migraine; four (16.7%) had seizures; and three (12.5%) had an intracranial hemorrhage. Twenty-two patients had at least one AVM (with a total of 28 AVMs), whereas two patients only had telangiectases. Twenty-seven AVMs were small (96%), 36% were located in eloquent areas of the brain, and 82% had superficial venous drainage. One third of the patients had multiple CVMs. The bleeding risk for patients with at least one AVM ranged from 0.41 to 0.72% per year, and for the whole cohort the range was 0.38 to 0.69% per year. Calculation of the bleeding risk as determined by lesion-years ranged from 0.36 to 0.56% per year for patients with AVMs and from 0.27 to 0.46% per year for all patients with CVMs.Conclusions. Patients with HHT have a high risk of harboring a CVM, especially in the presence of a pulmonary AVM. These CVMs are mostly low-grade AVMs (Spetzler—Martin Grade I or II), are frequently multiple, and have a lower risk of bleeding than that associated with sporadic AVMs. Female patients are more often affected than male patients. The inherent low sensitivity of DS angiography screening for CVMs may yield false negative results.

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An endovascular assisted, nonocclusive cerebral bypass: a technical feasibility study in a rabbit model

Journal of Neurosurgery ◽

10.3171/2020.3.jns20334 ◽

2020 ◽

pp. 1-6

Author(s):

Alexander Spiessberger ◽

Fabio Strange ◽

Basil Erwin Gruter ◽

Stefan Wanderer ◽

Daniela Casoni ◽

...

Keyword(s):

Rabbit Model ◽

High Flow ◽

Neurological Deficits ◽

Parent Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Intraoperative Angiography ◽

Novel Technique ◽

Bypass Patency ◽

Parent Vessel Occlusion

OBJECTIVETemporary parent vessel occlusion performed to establish a high-flow interpositional bypass carries the risk of infarcts. The authors investigated the feasibility of a novel technique to establish a high-flow bypass without temporary parent vessel occlusion in order to lower the risk of ischemic complications.METHODSIn 10 New Zealand white rabbits, a carotid artery side-to-end anastomosis was performed under parent artery patency with a novel endovascular balloon device. Intraoperative angiography, postoperative neurological assessments, and postoperative MRI/MRA were performed to evaluate the feasibility and safety of the novel technique.RESULTSA patent anastomosis was established in 10 of 10 animals; 3 procedure-related complications occurred. No postoperative focal neurological deficits were observed. The MRI/MRA findings include no infarcts and bypass patency in 50% of the animals.CONCLUSIONSThe authors demonstrated the feasibility of an endovascular assisted, nonocclusive high-flow bypass. Future refinement of the device and technique in an animal model is necessary to lower the complication rate and increase patency rates.

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