Usefulness of multislice computerized tomographic angiography in the postoperative evaluation of patients with clipped aneurysms

Acta Neurochir (Wien). 2010 May;152(5):793-802. doi: 10.1007/s00701-009-0465-4. Epub 2009 Jul 29.


Background: The aim of our study was to evaluate the diagnostic efficacy of multislice computed tomographic angiography (MSCTA) regarding exclusion quality after aneurysm clipping.

Methods: Sixty patients (74 aneurysms) underwent microsurgical exclusion using titanium clips. The presence of aneurysm remnants on MSCTA was compared by a neuroradiologist to 2D digital subtraction angiography (DSA), which was considered as a reference examination. The contribution of 3D DSA was assessed in a subpopulation of 29 patients (35 aneurysms).

Results: With 2D DSA, six aneurysm remnants (8%) were diagnosed, and only five (7%) by MSCTA. The specificity and sensitivity were 98.5 and 83%, respectively. MSCTA failed to demonstrate one large remnant (>2 mm) because of clip artifacts (six clips). With 3D DSA six supplementary remnants were diagnosed. Two were large remnants blinded by vessel overlaps and clip artifacts. Four were small "dog-eared" remnants (< or =2 mm). No additional treatment was required for small remnants.

Conclusion: In the postoperative period, MSCTA was considered a useful tool to evaluate the large remnants as well as a non-invasive ulterior examination for suspected bifurcation. Nevertheless, 3D DSA is still required for an accurate evaluation of aneurysms treated by more than three clips.

MeSH terms

  • Adult
  • Aged
  • Angiography, Digital Subtraction / methods
  • Angiography, Digital Subtraction / statistics & numerical data
  • Artifacts
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / pathology
  • Cerebral Arteries / surgery
  • Female
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Image Processing, Computer-Assisted / statistics & numerical data
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Neurosurgical Procedures / instrumentation
  • Neurosurgical Procedures / methods*
  • Outcome Assessment, Health Care / methods*
  • Postoperative Care / methods
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Surgical Instruments / standards
  • Tomography, X-Ray Computed / methods*
  • Tomography, X-Ray Computed / statistics & numerical data
  • Vascular Surgical Procedures / instrumentation
  • Vascular Surgical Procedures / methods*