Intraoperative 3D-Angiography Increases the Diagnostic Yield for Detection of Remnant during Microsurgical Aneurysm Occlusion

Introduction and Aim: The advantages of three-dimensional digital subtraction angiography (3D-DSA) over two-dimensional DSA (2D-DSA) for evaluation of the angioarchitecture of intracranial aneurysms (IA) have been previously reported. The introduction of modern intraoperative DSA (iDSA) technology within the environment of a hybrid operation room (hOR) allows immediate intraoperative evaluation of microsurgical IA occlusion. The aim of this study is to compare 2D-iDSA with 3D-iDSA findings after microsurgical IA occlusion.

Methods: A consecutive series of 118 patients who underwent microsurgical IA occlusion were retrospectively analyzed. In patients with documented IA remnants 2D- and 3D-iDSA images were re-evaluated and compared.

Results: A total of 21 (17.8%) and 14 (11.9%) cases presenting with IA remnant aneurysms were documented on 3D-iDSA and 2D-iDSA, respectively. The sensitivity of 2D-iDSA for detection of IA remnant compared with 3D-iDSA findings was 66.7% (14/21). The range of the 2D-iDSA sensitivity varied between 0 and 100% with a trend toward higher sensitivity in larger and lower sensitivity in smaller IA remnants.

Conclusions: This study demonstrated superiority of 3D-iDSA for detection of IA remnants after microsurgical occlusion compared with 2D-iDSA, especially for small IA remnants. According to our observations, 3D-iDSA might become the gold standard imaging technique for intraoperative evaluation of IA remnants. The performance of 3D-iDSA was observed to be feasible in the environment of the hOR. These observations have to be validated in larger series.