Clinical Significance of Routine Cerebral Angiography after Cerebral Aneurysm Surgery

OBJECTIVE: To identify the clinical significance of routine postoperative angiography, the incidence of residual aneurysms after clipping and the risk factors related to the occurrence of residual aneurysm are investigated. METHODS: Of 255 patients who underwent aneurysm clipping between 1999 and 2002, ninety one patients underwent routine angiography after aneurysm clipping by one surgeon. There were 104 aneurysms in these 91 patients. Postoperative angiography were reviewed. RESULTS: Of the 104 aneurysms, 9 (8.7%) had aneurysmal remnant on postoperative angiography. Incomplete clipping was intentionally performed in 4 aneurysms more than 10mm in size and in one basilar tip aneurysm. The remaining 4 aneurysms had unexpected remnant of sac, which was anterior choroidal artery aneurysm in 1 and anterior communicating artery aneurysms projecting superiorly or posterior-superiorly in 3. Thus, the true incidence of residual aneurysm was 3.8% (4/104 aneurysms). Logistic regression analysis showed the size of aneurysm as the only risk factor of residual aneurysm. Occlusion or narrowing of major artery was noted in 4.8%. Even though we had re-adjusted the clip in two cases because of parent arterial narrowing on postoperative angiography, two patients died due to cerebral infarction. CONCLUSION: Routine postoperative angiography has little clinical significance in view of the incidence and management of the residual aneurysm or major arterial narrowing/occlusion. Postoperative angiography seems to be necessary in limited patients after aneurysm surgery.

Indications of Postoperative Angiography after Surgical Treatment of Intracranial Aneurysms

OBJECTIVE: Subarachnoid hemorrhage(SAH) is still one of the most serious disease with high morbidity and mortality in the neurosurgical field. Clipping of the aneurysmal neck is the gold standard of the surgical treatment of aneurysmal SAH. The purpose of this study was to investigate the role of the postoperative angiography and to assess the risk factors related to the incomplete clipping. MATERIALS AND METHODS: From July 1995 to June 1998, the pre- and postoperative angiography were performed in 50 patients among total 81 patients who have underwent the aneurysmal surgery. We reviewed the various contributing factors including age, sex, Hunt-Hess grade, Fisher grade and the premature rupture of aneurysm during operation retrospectively. Careful evaluation of pre- and postoperative angiography focusing on the size, shape, and remnant neck of the aneurysms and vasospasm was performed. According to the angiographic findings, the patients were divided into two groups; a complete clipping group and an incomplete clipping group. The data were analyzed by using unpaired independent sample t test after F-test to compare the significance between two groups. RESULTS: Incomplete clipping of aneurysms was found in 6(12%) patients through the evaluation of postoperative angiography. Among them, three cases were located on the middle cerebral artery territory. Whereas the patient age, sex, Hunt-Hess grade, and Fisher grade were not significant(p<0.05), an intraoperative premature rupture had a statistical significance(p<0.05). A severe vasospasm occurred in 24(48%) cases and one patient with anterior communicating aneurysm was reoperated due to residual sac. CONCLUSION: According to our experience, the surgeons' judgement is the most reliable factor in deciding the postoperative angiography. During the aneurysmal surgery, the premature rupture always disturbs a complete clipping of aneurysms. Therefore, the temporary clipping of parent arteries is considered essential for a successful clipping. We believe that the postoperative angiography has a role in decreasing the re-bleeding risk due to clip migration and an inaccurate clipping only in the selected cases.