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.

 

MissingLinkText

No conflict of interest has been declared by the author(s).