Format

Send to

Choose Destination
World Neurosurg. 2018 Jun;114:e573-e580. doi: 10.1016/j.wneu.2018.03.035. Epub 2018 Mar 14.

Impact of Intraoperative 3-Dimensional Volume-Rendering Rotational Angiography on Clip Repositioning Rates in Aneurysmal Surgery.

Author information

1
Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan.
2
Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan; Department of Nursing, Tzu Hui Institute of Technology, Pingtung County, Taiwan.
3
Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
4
College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. Electronic address: ichangsu@gmail.com.

Abstract

OBJECTIVE:

Three-dimensional (3D) rotational angiography (RA), a gold standard imaging tool for the evaluation of cerebral aneurysms after clipping, can currently be performed intraoperatively in a hybrid operating room (OR). However, its role in intraoperative aneurysmal surgery is unclear. We aimed to study the value of intraoperative 2-dimensional digital subtraction angiography (2D-DSA) and 3D-RA for the evaluation of aneurysms after clipping, in terms of clip repositioning.

METHODS:

We included patients with cerebral aneurysms who were treated with microsurgical clipping in a hybrid OR. After aneurysmal clipping and indocyanine green video angiography assessment, intraoperative 2D-DSA and 3D-RA with volume-rendering (VR) images of the clipped aneurysm were obtained. The incidence rate of clip repositioning was determined, and aneurysm-related factors associated with suboptimal clipping that required clip revision after intraoperative angiography evaluation were analyzed.

RESULTS:

Between September 2016 and August 2017, 24 consecutive patients with 35 aneurysms were treated with microsurgical clipping. A clip repositioning rate of 17.1% was revealed after intraoperative 3D-VR imaging and initial indocyanine green-video angiography. 3D-VR was able to demonstrate all aneurysmal remnants, whereas 2D-DSA helped confirm flow stagnation in compromised vessels. Challenging aneurysms of size >7 mm (P = 0.043) and neck width >4 mm (P = 0.012) were significantly associated with a higher incidence of suboptimal aneurysmal clipping.

CONCLUSIONS:

A hybrid OR, with angiography facilities for high-resolution 2D-DSA and 3D-VR images, allows neurosurgeons to perform high-quality surgery. The routine use of intraoperative 3D-RA may not be necessary; however, it is invaluable for treating challenging aneurysms.

KEYWORDS:

Aneurysmal clipping; Challenging aneurysm; Clip reposition; Intracranial aneurysm; Intraoperative angiography; Three-dimensional

PMID:
29548950
DOI:
10.1016/j.wneu.2018.03.035
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center