Intraoperative Computed Tomographic Angiography in Cerebral Aneurysm Surgery

Abstract

To assess the feasibility and potential utility of intraoperative computed tomographic angiography (iCTA) in identifying unexpected residual aneurysms and major cerebral artery occlusion after cerebral aneurysm surgery. We prospectively studied 6 consecutive patients with ruptured anterior circulation aneurysms who underwent craniotomy and clipping. iCTA was performed in all cases after the surgeon was satisfied that the aneurysm was completely obliterated and the clip did not occlude a major artery. We analyzed the iCTA images with regard to residual aneurysm and major arterial occlusion and compared them with the postoperatively acquired angiographic images, which served as a control. Patient age and sex, aneurysm location and size, clinical presentation after rupture, and postoperative course, as well as postoperative modified Rankin Scale scores, were also recorded. One of the 6 patients had a residual aneurysm detected on the iCTA images, and it was confirmed on the immediate postoperative digital subtraction angiography. There were no cases of major arterial occlusion on iCTA imaging or postoperatively acquired angiographic imaging. iCTA is both feasible and potentially useful in identifying unexpected residual aneurysms and major arterial occlusion after surgical clipping of aneurysms.