Thorsteinsdottir, Jun and Schwarting, Julian and Forbrig, Robert and Siller, Sebastian and Tonn, Joerg-Christian and Liebig, Thomas and Schichor, Christian (2025) Detection of remnants in clipped unruptured intracranial aneurysms by intraoperative CT-angiography and postoperative DSA: clinical relevance and follow-up. ACTA NEUROCHIRURGICA, 167 (1): 109. ISSN 0001-6268, 0942-0940
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Background Aneurysm clipping is routinely performed with high efficacy and low complication rates in specialized neurovascular centers. Postoperative aneurysm remnants bear the risk of growth/rupture. Study aim was to analyze remnants in postoperative angiography (pDSA) and follow-up (FU) and to evaluate whether use of intraoperative CT-angiography (iCTA) can intraoperatively detect remnants and enable therapeutic consequences. Methods All patients undergoing elective aneurysm clipping at our center between 11/2012 and 12/2019 were included for FU in 01/2024. All patients received Indocyanin-green-videoangiography (ICGVA) and postoperative angiography (pDSA). After iCTA implementation in 10/2016, the majority of patients received additionally iCTA. Baseline characteristics, treatment-related morbidity/outcome, resulting operative conclusions in distinct cohorts with/without iCTA, and management of remnants according to Sindou classification were analyzed. Results 270 patients (367 enrolled/97 excluded) were clipped using iCTA in 74 patients. In 12/270 patients (4.5%) clip repositioning was performed due to ICGVA results, but iCTA further detected large remnants intraoperatively in 3/74 patients (4.1%) correctly resulting in re-clipping in two patients and recommendation for endovascular therapy in one patient. The specificity, sensitivity, and accuracy for detection of Sindou grade (SG) III-IV remnants by iCTA were 100%, 75%, and 98.6%, respectively. Overall, pDSA detected SG I-II remnants in 32/270 (11.9%) and SG III-V remnants in 8/270 (3.0%) patients with 3/270 requiring retreatment (n = 1 resurgery, n = 2 endovascular therapy). Frequency of SG I-V and III-V remnants were slightly lower in iCTA than non-iCTA group (10.8 vs. 16.3%, p < 0.173 and 1.4 vs. 3.6%, p < 0.306). All SG I-II and five SG III-V remnants did not reveal growth/rupture after a mean FU of 29 months. Conclusions Aneurysm remnants after clipping are rare and predominantly small (SGI-II)-not harbouring a risk of growth/rupture during short-term FU. Intraoperative CTA can detect large aneurysm remnants (SG III-IV) and may prompt adjustment of surgical strategy in individual cases.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | COMPUTED TOMOGRAPHIC ANGIOGRAPHY; DIGITAL-SUBTRACTION-ANGIOGRAPHY; INDOCYANINE GREEN VIDEOANGIOGRAPHY; CEREBRAL ANEURYSM; LONG-TERM; SURGERY; RISK; RECURRENCE; SERIES; Cerebral aneurysm; Clipping; Intraoperative computer tomography; Postoperative angiography |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurochirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 19 May 2026 06:08 |
| Last Modified: | 19 May 2026 06:08 |
| URI: | https://pred.uni-regensburg.de/id/eprint/67461 |
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