Intraoperative Three-Dimensional Angiography Increases the Diagnostic Yield for Detection of Neck Remnant during Microsurgical Aneurysm Occlusion

Aims: Intraoperative digital subtraction angiography (DSA) has been demonstrated to improve occlusion rates during microsurgical aneurysm treatment. Whether the addition of three-dimensional DSA (3D DSA) with immediate image reconstruction further enhances surgical outcome has not been investigated so far. Methods: A retrospective analysis was performed for patients undergoing microsurgical aneurysm occlusion in the hybrid OR between March 2011 and October 2014. The rate of intraoperatively detected neck remnant and clip repositioning was recorded. For verification, a delayed reevaluation was performed with two blinded neuroradiologists, who were asked to assess the surgical results based on 2D DSA in anteroposterior, lateral, and oblique views. In a second step, 3D DSA reconstructions were presented for analysis. Results: Of 142 patients (100 female, 42 male, mean age 56.1 years), 82 received intraoperative 3D DSA. Neck remnant was detected in 19 patients (23.2%). Surgical strategy and clip repositioning were performed in six patients (7.2%) just based on 3D DSA diagnostic, which were not detected in 2D views. Conclusion: Based on our preliminary observations, 3D DSA increases the diagnostic yield for intraoperative assessment of neck remnant in aneurysm surgery. 3D DSA might become a gold standard in hybrid neurovascular procedures to improve surgical results and patient's outcome. However, a prospective study has still to be performed.