title: Comparing routine versus selective use of intraoperative cerebral angiography in aneurysm surgery: a prospective study.
abstract: BACKGROUND
  While the use of intraoperative angiography (IA) has been shown to be a useful adjunct in aneurysm surgery, its routine use remains controversial.
  
  
  OBJECTIVE
  We wished to determine if IA is required in all patients undergoing aneurysm surgery (ie, routine IA) or if intraoperative assessment can reliably predict the need for IA (ie, select IA).
  
  
  METHODS
  We prospectively evaluated all patients undergoing craniotomy for aneurysm clipping. In these patients, the treating surgeons were asked to record whether they felt IA was required at two time points: (1) prior to surgery and (2) immediately after clip application but before IA. All patients underwent IA as per the institutional protocol. IA results and the need for post-IA clip adjustments were recorded.
  
  
  RESULTS
  Of the 200 patients enrolled, 197 were included for analysis. IA was deemed necessary on preoperative assessment in 144 cases (73%) and on post-clip assessment in 116 cases (59%). Post-clip IA demonstrated 47 (24%) positive findings and post-IA clip adjustments were made in 19 of 198 cases (10%). On preoperative assessment, there were four cases where IA was deemed unnecessary, yet post-IA clip adjustment was required, resulting in a sensitivity of 79% and false negative rate of 8%. Regarding post-clip assessment, there were five cases where IA was thought to be unnecessary and clip adjustment was required, resulting in a sensitivity of 73% and false negative rate of 6%.
  
  
  CONCLUSIONS
  The accuracy of a strategy of select IA was not improved by assessing the need for IA immediately after aneurysm clipping versus prior to surgery onset. This suggests that intraoperative assessment regarding the adequacy of aneurysm clip application should be viewed with caution.
authors.affiliation: Department of Neurological Surgery, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA Department of Radiology, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Chad W
authors.initials: CW
authors.lastname: Washington
authors.affiliation: Department of Neurological Surgery, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA Department of Radiology, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA Department of Neurology, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
authors.affiliation: Department of Neurological Surgery, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Chicoine
authors.affiliation: Department of Neurological Surgery, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA Department of Radiology, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: DeWitte T
authors.initials: DT
authors.lastname: Cross
authors.affiliation: Department of Neurological Surgery, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Dacey
authors.affiliation: Department of Neurological Surgery, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA Department of Radiology, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Moran
authors.affiliation: Department of Neurological Surgery, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA Department of Radiology, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Rich
authors.affiliation: Department of Neurological Surgery, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA Department of Neurology, Washington University Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Zipfel
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods / Q000592:standards*; D002533:Cerebral Angiography / Q000379:methods / Q000592:standards*; D003399:Craniotomy; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards*; D011300:Preoperative Care / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: Aneurysm; Angiography; Subarachnoid