Safety and efficacy of intraoperative angiography in craniotomies for cerebral aneurysms and arteriovenous malformations: A review of 1093 consecutive cases

Nohra Chalouhi, Thana Theofanis, Pascal Jabbour, Aaron S. Dumont, L. Fernando Gonzalez, Robert M. Starke, Richard T. Dalyai, Shannon Hann, Robert Rosenwasser, Stavropoula Tjoumakaris

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

BACKGROUND: In an era of indocyanine angiography, the routine use of intraoperative angiography (IOA) in the surgical treatment of aneurysms and vascular malformations is controversial. OBJECTIVE: To retrospectively assess the safety and efficacy of IOA and to determine predictors of surgical revision. METHODS: Between 2003 and 2011, IOA was performed during surgical treatment of 976 aneurysms, 101 arteriovenous malformations (AVMs), and 16 arteriovenous fistulas. RESULTS: In 80 of 976 aneurysms (8.2%), IOA prompted clip repositioning. The reason for readjustment was residual aneurysm in 54.7%, parent vessel occlusion in 42.9%, and both in 2.4% of cases. In multivariate analysis, increasing aneurysm size (P<.001), ruptured aneurysm (P<.001), and increasing number of vessels injected (P<.001) were strong predictors of clip readjustment. There was a strong trend for posterior circulation aneurysm location to predict clip repositioning (P=.06). IOA revealed residual nidus/fistula requiring further intervention in 9 of 101 AVMs (8.9%) and 3 of 16 arteriovenous fistulas (18.8%). Of 9 AVMs requiring a surgical revision, 2 (22.2%) were Spetzler-Martin grade II, 5 (55.6%) were grade III, and 2 (22.2%) were grade IV. Mean Spetzler-Martin grade was 3.0 in AVMs requiring surgical revision compared with 2.3 in those not requiring revision (P=.05). IOA-related complications were all transient or minor and occurred in 0.99% of patients; none resulted in permanent morbidity. CONCLUSION: IOA remains a valuable tool in the surgical treatment of brain vascular abnormalities, guiding surgical re-exploration in >8% of cases. Easy access to an angiographer and routine use of IOA are important factors contributing to procedural safety and efficacy.

Original languageEnglish (US)
Pages (from-to)1162-1169
Number of pages8
JournalNeurosurgery
Volume71
Issue number6
DOIs
StatePublished - Dec 2012
Externally publishedYes

Keywords

  • Aneurysm
  • Arteriovenous fistula
  • Arteriovenous malformation
  • Intraoperative angiography

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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