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Usefulness of multislice computerized tomographic angiography in the postoperative evaluation of patients with clipped aneurysms

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Abstract

Background

The aim of our study was to evaluate the diagnostic efficacy of multislice computed tomographic angiography (MSCTA) regarding exclusion quality after aneurysm clipping.

Methods

Sixty patients (74 aneurysms) underwent microsurgical exclusion using titanium clips. The presence of aneurysm remnants on MSCTA was compared by a neuroradiologist to 2D digital subtraction angiography (DSA), which was considered as a reference examination. The contribution of 3D DSA was assessed in a subpopulation of 29 patients (35 aneurysms).

Results

With 2D DSA, six aneurysm remnants (8%) were diagnosed, and only five (7%) by MSCTA. The specificity and sensitivity were 98.5 and 83%, respectively. MSCTA failed to demonstrate one large remnant (>2 mm) because of clip artifacts (six clips). With 3D DSA six supplementary remnants were diagnosed. Two were large remnants blinded by vessel overlaps and clip artifacts. Four were small “dog-eared” remnants (≤2 mm). No additional treatment was required for small remnants.

Conclusion

In the postoperative period, MSCTA was considered a useful tool to evaluate the large remnants as well as a non-invasive ulterior examination for suspected bifurcation. Nevertheless, 3D DSA is still required for an accurate evaluation of aneurysms treated by more than three clips.

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Acknowledgement

The authors are grateful to Richard Medeiros, Rouen University Hospital, Medical Editor, for editing the manuscript.

The authors confirm that there is no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Authors and Affiliations

  1. Department of Neuroradiology, Rouen University Hospital, 1, rue de Germont, 76031, Rouen-cedex, France

    Emmanuel Gerardin, Eléonore Tollard, Jean-Nicolas Dacher & Françoise Douvrin

  2. LITIS, Equipe d’Accueil 4108, Rouen University Hospital, Rouen, France

    Emmanuel Gerardin & Jean-Nicolas Dacher

  3. Department of Neurosurgery, Rouen University Hospital, Rouen, France

    Stéphane Derrey, Olivier Langlois, Pierre Freger & François Proust

Authors
  1. Emmanuel Gerardin
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  2. Eléonore Tollard
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  3. Stéphane Derrey
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  4. Olivier Langlois
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  5. Jean-Nicolas Dacher
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  6. Françoise Douvrin
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  7. Pierre Freger
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  8. François Proust
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Corresponding author

Correspondence to Emmanuel Gerardin.

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Comments

Digital subtraction angiography (2D or even better 3D) is still the most reliable method to evaluate patients postoperatively for possible aneurysm remnants. However, DSA as an invasive procedure has an inherent morbidity and mortality rate. Thus, the advent of less invasive procedures (CT or MR angiography) should reduce these procedure-related risks; however, an exact analysis of the pros and cons of every new follow-up regimen has to be performed. The present paper provides useful information about the comparison of MSCTA and 2D DSA (and in a subpopulation also 3D DSA), even though there are also other recently published papers reporting similar results (e.g., 1-3). Further, the present paper has significant methodological weaknesses, which have to be considered in the interpretation of the results presented: This is not a prospective study, the patients included do not represent a consecutive series, the time between surgery and postoperative DSA was variable as was the time between DSA and MSCTA, and 3D DSA was performed only in a subpopulation and not in all patients. However, on the other hand one has to consider that it would be very difficult to perform a high-level prospective, randomized, controlled study about this topic—especially when taking the problem of radiation exposure into account.

1. Chen W, Yang Y, Qiu J, Peng Y, Xing W (2008) Sixteen-row multislice computerized tomography angiography in the postoperative evaluation of patients with intracranial aneurysms. Br J Neurosurg 22: 63-70

2. Dehdashti AR, Binaghi S, Uske A, Regli L (2006) Comparison of multislice computerized tomography angiography and digital subtraction angiography in the postoperative evaluation of patients with clipped aneurysms. J Neurosurg 104: 395-403

3) Uysal E, Ozel A, Erturk SM, Kidar Ö, Basak M (2009) Comparison of multislice computed tomography angiography and digital subtraction angiography in the detection of residual or recurrent aneurysm after surgical clipping with titanium clips. Acta Neurochir (Wien) 151: 131-135

Marcus Reinges

Aachen, Germany

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Gerardin, E., Tollard, E., Derrey, S. et al. Usefulness of multislice computerized tomographic angiography in the postoperative evaluation of patients with clipped aneurysms. Acta Neurochir 152, 793–802 (2010). https://doi.org/10.1007/s00701-009-0465-4

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  • DOI: https://doi.org/10.1007/s00701-009-0465-4

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