Comparison of Subtracted Computed Tomography from Computed Tomography Perfusion and Digital Subtraction Angiography in Residue Evaluation of Treated Intracranial Aneurysms

Dündar, Tolga Turan; Aralaşmak, Ayşe; Kitiş, Serkan; Yilmaz, Fatih Temel; Abdallah, Anas

doi:10.1016/j.wneu.2019.08.028

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…Although no statistically significant relationship was reported, some studies continue to associate aneurysm location with incomplete treatment ( 1 , 2 , 3 , 15 ). In the study of Jabbarli et al ( 10 ), the incidence of residual aneurysm was 18.2% of the 659 aneurysms studied, which was lower than the 23% observed in the present study.…”

Section: Discussionmentioning

confidence: 98%

“…Given the clear need for long-term follow-up of operated aneurysms, these lesions should be controlled by using imaging. Although many studies have employed computed tomography angiography and magnetic resonance angiography for follow-up, DSA remains the method offering best accuracy and specificity for diagnosing residual lesions after microsurgical treatment of cerebral aneurysms ( 2 , 14 , 15 ). DSA yields information on clip position, presence of residual lesions, occlusion, or stenosis of adjacent vessels, and the presence of other untreated aneurysms ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Residual lesions in patients undergoing microsurgical clipping of cerebral aneurysms in a reference university hospital

Aguiar

Kormanski

Corrêa

et al. 2020

Clinics

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Residual lesions in patients undergoing microsurgical clipping of cerebral aneurysms in a reference university hospital

Aguiar

Kormanski

Corrêa

et al. 2020

Clinics

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“…CT angiography (CT-A) is less invasive and has been compared to classical DSA in different studies. The sensitivity for detection of postoperative aneurysm remnants varied between 50-100% comparing CT-A to DSA [6,11,14,23,30,33,34]. The precision of the CT-A strongly decreases with the usage of multiple clips, in cases with posterior circulation aneurysms and in small remnants.…”

Section: Risk Factors For Incomplete Aneurysm Occlusionmentioning

confidence: 99%

“…Dundar et al compared traditional DSA to subtraction CT-A and came to the conclusion that DSA remains the gold standard as residuals < 3 mm are not reliably examined with CT-A [14].…”

Section: Risk Factors For Incomplete Aneurysm Occlusionmentioning

confidence: 99%

Frequency and risk factors for postoperative aneurysm residual after microsurgical clipping

et al. 2020

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Objective Aneurysm residuals after clipping are a well-known problem, but the course of aneurysm remnants in follow-up is not well studied. No standards or follow-up guidelines exist for treatment of aneurysm remnants. The aim of this study was to evaluate the risk factors for postoperative aneurysm remnants and their changes during follow-up. Methods We performed a retrospective analysis of 666 aneurysms treated via clipping in our hospital from 2006 to 2016. Postoperative and follow-up angiographic data were analyzed for aneurysm remnants and regrowth. Clinical parameters and aneurysm-specific characteristics were correlated with radiological results. Results The frequency of aneurysm residuals was 12% (78/666). Aneurysms located in the middle cerebral artery (p = 0.02) showed a significantly lower risk for incomplete aneurysm occlusion. Larger aneurysms with a diameter of 11–25 mm (p = 0.005) showed a significantly higher risk for incomplete aneurysm occlusion. Five patients underwent re-clipping during the same hospital stay. Remnants were stratified based on morphological characteristics into “dog ears” (n = 60) and “broad based” (n = 13). The majority of the “dog ears” stayed stable, decreased in size, or vanished during follow-up. Broad-based remnants showed a higher risk of regrowth. Conclusions A middle cerebral artery location seems to lower the risk for the incomplete clip occlusion of an aneurysm. Greater aneurysm size (11–25 mm) is associated with a postoperative aneurysm remnant. The majority of “dog-ear” remnants appear to remain stable during follow-up. In these cases, unnecessarily frequent angiographic checks could be avoided. By contrast, broad-based residuals show a higher risk of regrowth that requires close imaging controls if retreatment cannot be performed immediately.

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“…Despite all advancements and refinements of intensive care units, surgical tools, equipments, and micro neurosurgical techniques, aneurysmal SAH has a poor prognosis that remained relatively unaffected (7)(8)(9)(10) . Through an exhaustive review, we found that SAH has a high mortality rate of up to 40%, while 60% of the surviving patients with SAH can have serious neurological limitations and need other individuals' support and help (7,11) .…”

Section: Introductionmentioning

confidence: 99%

Demographic Distribution and Long-Term Surgical Outcomes of Intracranial Aneurysms Operated at a Tertiary Institute: A Retrospective Study

Asiltürk¹

2020

BMJ

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Objective: To evaluate the demographic distribution and the long-term surgical outcomes of intracranial aneurysms (IAs) at a tertiary health institute. Method: I retrospectively reviewed the medical records of 398 patients with IAs who underwent surgical intervention at our tertiary health institute within 3 years, between 2011 and 2013. The demographic distribution regarding the patients' cities and their long-term surgical outcomes were evaluated. Results: Sixty-one (36 females, 25 males) patients were from Istanbul. Majority (14.6%) of our patients (n=120: 71 females, 49 males) with IAs came from the Marmara region. The locations of IAs in our patients with subarachnoid hemorrhage (SAH) were antrerior communicating artery (AcoA) (n=78), middle cerebral artery (MCA) (n=74), multiple aneurysms (67), internal cerebral artery (ICA) (n=24), posterior communicating artery (PcoA) (n=13), anterior cerebral artery (ACA) (n=7), superior cerebellar artery (SCA) (n=6), and posterior cerebral artery (PCA) (n=5), whereas the locations of incidentally diagnosed IAs were MCA (45), ACoA (32), multiple (23), ICA (22), PCoA, ACA, and PCA one each artery. The mortality and morbidity rates were higher in SAH patients 16.7%-10.6% (15%-3% in patients with incidentally diagnosed IAs). The rate of the patients who returned to their normal daily activities was higher. Conclusion: A higher rate of postoperative hydrocephalus was observed in patients with multiple aneurysms. There was no relation between sex and morbidity and mortality rates. SAH patients presented with multiple aneurysms had a higher morbidity rate. Advanced age (> 65) and MCA location were associated with a higher mortality rate, while locations of ICA (especially ophthalmic), PCoA, and ACoA were associated with a higher morbidity rate.

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Comparison of Subtracted Computed Tomography from Computed Tomography Perfusion and Digital Subtraction Angiography in Residue Evaluation of Treated Intracranial Aneurysms

Cited by 7 publications

References 17 publications

Residual lesions in patients undergoing microsurgical clipping of cerebral aneurysms in a reference university hospital

Residual lesions in patients undergoing microsurgical clipping of cerebral aneurysms in a reference university hospital

Frequency and risk factors for postoperative aneurysm residual after microsurgical clipping

Demographic Distribution and Long-Term Surgical Outcomes of Intracranial Aneurysms Operated at a Tertiary Institute: A Retrospective Study

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