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Intraoperative angiography should be standard in cerebral aneurysm surgery.

Friedman JA, Kumar R - BMC Surg (2009)

Bottom Line: Intraoperative angiography (IOA) has proven to be a safe and effective adjunct to surgical repair of cerebral aneurysms.Substantial practice variation exists regarding use of this modality in different centers, including use of IOA routinely, selectively, or rarely.In this editorial, we discuss our experience and review the existing literature to develop an argument for routine use of IOA during cerebral aneurysm surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Texas A&M Health Science Center College of Medicine, Bryan, TX 77802 USA. jafriedman@medicine.tamhsc.edu

ABSTRACT
Intraoperative angiography (IOA) has proven to be a safe and effective adjunct to surgical repair of cerebral aneurysms. Substantial practice variation exists regarding use of this modality in different centers, including use of IOA routinely, selectively, or rarely. In this editorial, we discuss our experience and review the existing literature to develop an argument for routine use of IOA during cerebral aneurysm surgery.

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Intraoperative angiogram demonstrating occlusion of middle cerebral artery aneurysm with patency of middle cerebral branches. The anterior communicating artery aneurysm is also occluded, but there is no filling of the anterior cerebral artery, suggesting parent vessel occlusion by the clip.
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Figure 2: Intraoperative angiogram demonstrating occlusion of middle cerebral artery aneurysm with patency of middle cerebral branches. The anterior communicating artery aneurysm is also occluded, but there is no filling of the anterior cerebral artery, suggesting parent vessel occlusion by the clip.

Mentions: The fundamental value of IOA during aneurysm repair is to confirm complete occlusion of the aneurysm, and to demonstrate patency of surrounding vasculature (Figure 1, 2 and 3). As many as 5% – 7.3% of surgically treated aneurysms are unexpectedly incompletely occluded, leading to additional treatment or to ongoing risk of rupture.[1,2] Without IOA, the surgeon's only means to confirm complete aneurysm occlusion is to puncture the aneurysm dome – an incompletely occluded aneurysm will hemorrhage from the puncture site, which although not usually problematic is certainly not an optimal means to discover incomplete aneurysm occlusion. Parent vessel occlusion during surgical clipping of a cerebral aneurysm occurs in approximately 3 – 9% of cases.[1,3-5] Although rare, parent vessel occlusion can lead to permanent neurological deficit or death. Furthermore, only a small window of time exists in which to recognize parent vessel occlusion and restore flow before irreversible ischemia of brain parenchyma will occur, such that postoperative investigations demonstrating parent vessel occlusion do not generally lead to successful intervention. Because IOA can demonstrate both incomplete aneurysm occlusion and parent vessel occlusion in a facile and timely manner, and lead to corrective intervention during the initial craniotomy, IOA has significant potential to improve surgical outcomes.


Intraoperative angiography should be standard in cerebral aneurysm surgery.

Friedman JA, Kumar R - BMC Surg (2009)

Intraoperative angiogram demonstrating occlusion of middle cerebral artery aneurysm with patency of middle cerebral branches. The anterior communicating artery aneurysm is also occluded, but there is no filling of the anterior cerebral artery, suggesting parent vessel occlusion by the clip.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2683796&req=5

Figure 2: Intraoperative angiogram demonstrating occlusion of middle cerebral artery aneurysm with patency of middle cerebral branches. The anterior communicating artery aneurysm is also occluded, but there is no filling of the anterior cerebral artery, suggesting parent vessel occlusion by the clip.
Mentions: The fundamental value of IOA during aneurysm repair is to confirm complete occlusion of the aneurysm, and to demonstrate patency of surrounding vasculature (Figure 1, 2 and 3). As many as 5% – 7.3% of surgically treated aneurysms are unexpectedly incompletely occluded, leading to additional treatment or to ongoing risk of rupture.[1,2] Without IOA, the surgeon's only means to confirm complete aneurysm occlusion is to puncture the aneurysm dome – an incompletely occluded aneurysm will hemorrhage from the puncture site, which although not usually problematic is certainly not an optimal means to discover incomplete aneurysm occlusion. Parent vessel occlusion during surgical clipping of a cerebral aneurysm occurs in approximately 3 – 9% of cases.[1,3-5] Although rare, parent vessel occlusion can lead to permanent neurological deficit or death. Furthermore, only a small window of time exists in which to recognize parent vessel occlusion and restore flow before irreversible ischemia of brain parenchyma will occur, such that postoperative investigations demonstrating parent vessel occlusion do not generally lead to successful intervention. Because IOA can demonstrate both incomplete aneurysm occlusion and parent vessel occlusion in a facile and timely manner, and lead to corrective intervention during the initial craniotomy, IOA has significant potential to improve surgical outcomes.

Bottom Line: Intraoperative angiography (IOA) has proven to be a safe and effective adjunct to surgical repair of cerebral aneurysms.Substantial practice variation exists regarding use of this modality in different centers, including use of IOA routinely, selectively, or rarely.In this editorial, we discuss our experience and review the existing literature to develop an argument for routine use of IOA during cerebral aneurysm surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Texas A&M Health Science Center College of Medicine, Bryan, TX 77802 USA. jafriedman@medicine.tamhsc.edu

ABSTRACT
Intraoperative angiography (IOA) has proven to be a safe and effective adjunct to surgical repair of cerebral aneurysms. Substantial practice variation exists regarding use of this modality in different centers, including use of IOA routinely, selectively, or rarely. In this editorial, we discuss our experience and review the existing literature to develop an argument for routine use of IOA during cerebral aneurysm surgery.

Show MeSH
Related in: MedlinePlus