Introduction: Use of intraoperative angiography (IA) during craniotomy for treatment of aneurysms is debated. Longer operative and anesthetic times for IA have been cited as potential downfalls. Another possible complication of IA not previously investigated is the potential for increased infections complications secondary to higher room traffic for angiography, use of additional equipment, and need for intraoperative groin. We aim to describe the infectious risk of using IA at our institution.
Methods: A retrospective cohort study was performed of all patients undergoing craniotomy for aneurysm treatment between 2005-2012 at the University of Michigan. IA was used at the surgeon’s discretion. Primary outcome was occurrence of surgical site infection and secondary outcome was occurrence of IA influencing clip repositioning. Patient variables included demographics, medical co-morbidities, use of ventriculostomy, and use of IA. Univariate and multi-variate analyses were performed using 2-sample t-tests, the Mann-Whitney U test, and logistic regression; a p-value < 0.05 was considered statistically significant.
Results: During the study period, 676 intracranial aneurysms were treated by craniotomy; IA was used in 104 of these cases. There were a total of 20 surgical site infections, 2 in the IA group (1.9%) and 18 in the non-IA group (3.1%), indicating that IA was not a statistically significant variable for infection (p = 0.50). No additional single variable measured could be identified to have a statistically significant increase in infection, and there were no direct complications related to use of IA (stroke, dissection, perforation). Repositioning of the clip secondary to IA occurred in 22 cases (21%).
Conclusions: IA is not associated with increased risk of infection, but did affect clip placement in 20% of cases in which it was utilized, and should therefore not be withheld for fear of infectious complications.
Patient Care: Our study demonstrates that there is no additional infectious risk when using IA during craniotomy for treatment of intracranial aneurysms, but can affect microsurgical clip placement in a large number of cases. Given the low risk of using IA, including low risk of infection, we hope to show that IA should be used with little hesitation if the surgeon feels it might be beneficial to understand the angioarchitecture of the operative field. It is our hope that studies such as ours will increase the awareness of the benign nature of IA with potential dramatic benefits to patient care.
Learning Objectives: Learning Objectives:
Recognize that IA is not associated with an increase in surgical site complications.
Appreciate that IA can affect clip positioning in nearly a quarter of cases when used appropriately.
Understand that IA does not impart a significant additional risk to the patient.