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  • Intraoperative Cerebral Angiography in Intracranial Aneurysm Surgery Reduced Occurrence of Postoperative Cerebral Ischemia and Rebleeding: a Retrospective Study of 155 Patients

    Final Number:

    Yi Jonathan Zhang MD; Taylor L. Gist MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Intraoperative cerebral angiography (IOA) is now commonly utilized in intracranial aneurysm surgery to confirm satisfactory aneurysm occlusion and normal vasculature preservation. Cerebral ischemia is a known risk from branch compromise at the treated aneurysm necks. There is sparse data on the safety and efficacy of intraoperative angiography in aneurysm surgery compared to microsurgical treatment alone.

    Methods: A prospective neurosurgical database in a single institution was retrospectively reviewed over 5 years (8/2007-9/2012) to identify consecutive patients who had undergone craniotomy for treatment of intracranial aneurysms. Both ruptured and unruptured aneurysms were included. Patients were separated into two groups: those who had undergone microsurgical treatment with IOA and those who underwent microsurgery alone. The incidences of imaging confirmed (CT or MR) perioperative cerebral ischemia and 30-day aneurysm rebleeding were collected for both groups. Two-tailed Fisher’s exact test was utilized for statistical analysis.

    Results: A total of 155 patients were included in the study. 109 of the patients had undergone microsurgery with IOA while 46 patients underwent microsurgery alone. The decision of IOA use was based on individual neurosurgeon preference. 5 patients in the IOA group and 6 patients in the group without IOA had imaging confirmed perioperative cerebral ischemic events. One patient without IOA suffered rebleeding from the clipped aneurysm three weeks postoperatively, while none in the IOA group. No direct adverse event was noted for IOA procedures. Hence, the perioperative cerebrovascular complication rate is 4.6% for the IOA group and 15.2% for the non-IOA group, a statistically significant difference (p = 0.04).

    Conclusions: During intracranial aneurysm surgeries, patients who underwent intraoperative cerebral angiography experienced less perioperative cerebral ischemia and aneurysmal rebleeding when compared to those who underwent microsurgery alone in this retrospective study. Intraoperative cerebral angiography is a safe and effective adjunct to microsurgery in the treatment of both ruptured and unruptured intracranial aneurysms in the appropriate settings.

    Patient Care: This study demonstrated that IOA use in intracranial aneurysm surgery can lead to less perioperative cerebrovascular complications in the appropriate settings.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of intraoperative cerebral angiography in aneurysm surgery; 2) Discuss, the potentials of IOA in reducing perioperative complications of aneurysm surgery; 3) Identify an effective strategy in IOA utilization.


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