TECHNIQUES AND USE OF INTRAOPERATIVE ANGIOGRAPHY

ABSTRACT

The goal of cerebrovascular surgical procedures for surgical repair of an aneurysm or excision of a cerebral arteriovenous malformation is to achieve total obliteration of the lesion with preservation of normal vascular anatomy. Although there is no substitute for direct visual inspection at high magnification, other adjuncts such as intraoperative digital subtraction angiography may avoid inadvertent occlusion or efferent vessels or residual malformation.

Analysis included data on 250 intraoperative angiograms, 83% of which had intracranial aneurysms, and 15% of which had pial AVMs. Of the 250 patients, 30 cases or 12% of the entire group demonstrated either inadequate clipping of the aneurysm, or residual AVM.

Aneurysm location also played a role in paraclinoid lesions, particularly in the parathalmic and superior hypophyseal region. In 82% of the cases, clips needed to be readjusted. Complex lesions and size also played an important role in determining the need for intraoperative DSA. Technical considerations regarding the application of intraoperative DSA will also be discussed.

KEYWORD

Intraoperative angiography - neurovascular disease

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