Intraoperative Cerebral Angiography in Intracranial Aneurysm Surgery Reduced Occurrence of Postoperative Cerebral Ischemia and Rebleeding: a Retrospective Study of 155 Patients Yi Jonathan Zhang MD; Taylor L. Gist MD Methodist Neurological Institute Houston Methodist Hospital

Introduction Results SAH from Ruptured Acomm Aneurysm Learning Objectives Intraoperative cerebral angiography A total of 155 patients were included By the conclusion of this session, (IOA) is now commonly utilized in in the study. 109 of the patients had participants should be able to: 1) intracranial aneurysm surgery to undergone microsurgery with IOA confirm satisfactory aneurysm while 46 patients underwent Describe the importance of occlusion and normal vasculature microsurgery alone. The decision of intraoperative cerebral angiography preservation. Cerebral ischemia is a IOA use was based on individual in aneurysm surgery; 2) Discuss, the known risk from branch compromise neurosurgeon preference. 5 patients potentials of IOA in reducing at the treated aneurysm neck. There in the IOA group and 6 patients in the perioperative complications of is sparse data on the safety and group without IOA had imaging efficacy of intraoperative angiography confirmed perioperative cerebral aneurysm surgery; 3) Identify an in aneurysm surgery compared to ischemic events. One patient without effective strategy in IOA utilization. Aneurysm clipped without IOA microsurgical treatment alone. IOA suffered rebleeding from the clipped aneurysm three weeks Rebleed 3 Weeks Post-Op References Methods postoperatively, while none in the IOA 1.Chalouhi N et al. Safety and Efficacy A prospective neurosurgical database group rebled. No direct adverse event of Intraoperative Angiography in in a single institution was was noted for IOA procedures. Hence, Craniotomies for Cerebral Aneurysms retrospectively reviewed over 5 years the perioperative cerebrovascular and Arteriovenous Malformations: A (8/2007-9/2012) to identify complication rate was 4.6% for the Review of 1093 Consecutive Cases. consecutive patients who had IOA group and 15.2% for the non-IOA Neurosurgery. 2012;71(6):1162-1169. undergone craniotomy for treatment group, a statistically significant 2.Chiang VL et al. Routine of intracranial aneurysms. Both difference (p = 0.04). intraoperative angiography during ruptured and unruptured aneurysms aneurysm surgery. J Neurosurg. were included. Patients were Conclusions 2002;96(6):988–992. separated into two groups: those who Patients who underwent intraoperative 3.Kivisaari RP et al. Routine cerebral had undergone microsurgical cerebral angiography during angiography after surgery for saccular treatment with IOA and those who intracranial aneurysm surgery Partially clipped aneurysm found and aneurysms: is it worth it? underwent microsurgery alone. The experienced less perioperative treated with coil embolization. Neurosurgery. 2004;55(5):1015–1024. incidences of imaging confirmed (CT cerebral ischemia and aneurysmal 4.Klopfenstein JD et al. Comparison of or MR) perioperative cerebral ischemia rebleeding when compared to those routine and selective use of and 30-day aneurysm rebleeding were who underwent microsurgery alone in intraoperative angiography during collected for both groups. Two-tailed this retrospective study. aneurysm surgery: a prospective Fisher’s exact test was utilized for Intraoperative cerebral angiography is assessment. J Neurosurg. statistical analysis. a safe and effective adjunct to 2004;100(2):230–235. microsurgery in the treatment of both 5.Tang G et al. Intraoperative ruptured and unruptured intracranial angiography during aneurysm surgery: aneurysms in the appropriate settings. a prospective evaluation of efficacy. J Neurosurg. 2002;96(6):993–999.