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首页> 外文期刊>Neurosurgery >Routine Cerebral Angiography after Surgery for Saccular Aneurysms: Is It Worth It?
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Routine Cerebral Angiography after Surgery for Saccular Aneurysms: Is It Worth It?

机译：囊性动脉瘤手术后的常规脑血管造影：是否值得？

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OBJECTIVE: The objective of this study was to determine whether an angiographically proven rate of saccular intracranial aneurysm occlusion after surgical clipping suggests that postoperative angiography should continue to be used routinely or should be supplanted by intraoperative angiography. These data also should establish a basis for comparing surgery with new endovascular methods of treatment. METHODS: During a 3.5-year period, a consecutive series of 622 patients (955 aneurysms, 808 of which were surgically clipped) who underwent postoperative angiography were studied retrospectively. This series comprised 493 ruptured and 315 unruptured aneurysms. RESULTS: Complete aneurysm closure was achieved in 88% of aneurysms, a neck remnant was discovered in 9%, and a fundus remnant was revealed in 3%. Of 493 ruptured aneurysms, 86% were completely occluded. Of 315 unruptured aneurysms, 91% were completely occluded. The results for clipping of complex aneurysms, i.e., posterior circulation or large to giant aneurysms, were significantly inferior to those for small and anterior circulation aneurysms. In one-third of the large and giant aneurysms, a part of the base was left intentionally because of calcifications or strong wall or to prevent occlusion of any branches. In the series, a significant 5% complication rate of major vessel occlusion was detected. CONCLUSION: Our retrospective analysis revealed that ruptured, posterior circulation, and large/giant aneurysms are more prone to incomplete clipping. Therefore, these aneurysms require postoperative if not intraoperative evaluation with angiography. Many clippings of anterior circulation aneurysms experience unexpected failures, which suggests that intraoperative angiography could be beneficial. This series, which has no selection bias, can be used as a basis to compare the results of other series reporting surgical or endovascular treatment.
机译：目的：本研究的目的是确定在手术钳夹后经血管造影证实的囊状颅内动脉瘤闭塞率提示术后应继续常规使用血管造影术或应通过术中血管造影术予以替代。这些数据也应为比较外科手术与新的血管内治疗方法建立基础。方法：在3.5年的时间里，回顾性分析了连续622例接受了术后血管造影术的患者（955例动脉瘤，其中808例被手术切除）。该系列包括493例破裂和315例未破裂的动脉瘤。结果：88％的动脉瘤完全闭塞，9％的患者发现颈部残余，3％的患者发现眼底残余。在493个破裂的动脉瘤中，有86％被完全阻塞。在315个未破裂的动脉瘤中，有91％被完全阻塞。复杂的动脉瘤（即后循环或大到巨型动脉瘤）的截留结果明显不及小而前循环的动脉瘤。在三分之一的大而巨大的动脉瘤中，由于钙化或结实的壁或为了防止任何分支的闭塞而故意留下了一部分基底。在该系列中，检测到大血管闭塞的并发症发生率高达5％。结论：我们的回顾性分析显示，破裂，后循环和大/巨大的动脉瘤更容易发生不完全的夹闭。因此，如果不进行术中血管造影术评估，这些动脉瘤需要进行术后评估。前循环动脉瘤的许多修剪经历了意想不到的失败，这表明术中血管造影可能是有益的。该系列没有选择偏倚，可以用作比较其他报道手术或血管内治疗的系列结果的基础。

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