Evaluation of the yield of post-clipping angiography and nationwide current practice
| Autor: | Peter W. A. Willems, R. Ghaznawi, R. W. Koot, M.A.A. van Walderveen, N. Scheer |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Original Article - Vascular Neurosurgery - Aneurysm medicine.medical_specialty Adolescent medicine.medical_treatment Sensitivity and Specificity 030218 nuclear medicine & medical imaging Cohort Studies Young Adult 03 medical and health sciences 0302 clinical medicine Aneurysm Occlusion medicine Humans Postoperative Period cardiovascular diseases Child Aged Netherlands Retrospective Studies medicine.diagnostic_test business.industry Angiography Digital Subtraction Intracranial Aneurysm Retrospective cohort study Digital subtraction angiography Clipping (medicine) Middle Aged medicine.disease Ruptured Cerebral Angiography Residual Angiography Retreatment cardiovascular system Unruptured Female Surgery Neurology (clinical) Radiology Neurosurgery business Saccular aneurysm 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Acta Neurochirurgica, 161(4), 783-790 Acta Neurochirurgica |
| DOI: | 10.1007/s00701-019-03834-3 |
| Popis: | Background Surgical treatment of intracranial saccular aneurysms aims to prevent (re)hemorrhage by complete occlusion of the aneurysmal lumen. It is unclear whether routine postoperative imaging, to assess aneurysmal occlusion, is necessary since intraoperative assessment by the neurosurgeon may be sufficient. We assessed routine clinical protocols for post-clipping imaging in the Netherlands and determined whether intraoperative assessment of aneurysm clippings sufficiently predicts aneurysm residuals. Methods A survey was conducted to assess postoperative imaging protocols in centers performing clipping of intracranial aneurysms in the Netherlands (n = 9). Furthermore, a retrospective single-center cohort study was performed to determine the predictive value of intraoperative assessment of aneurysm occlusion in relation to postoperative digital subtraction angiography (DSA) findings, between 2009 and 2017. Results No center performed intraoperative DSA in a hybrid OR, routinely. Respectively, four (44.4%), seven (77.8%), and three (33.3%) centers did not routinely perform early postoperative imaging, late follow-up imaging, or any routine imaging at all. Regarding our retrospective study, 106 patients with 132 clipped aneurysms were included. There were 23 residuals ≥ 1 mm (17.4%), of which 10 (43.5%) were unexpected. For the presence of these residuals, intraoperative assessment showed a sensitivity of 56.5%, a specificity of 86.2%, a positive predictive value of 46.4%, and a negative predictive value of 90.4%. Conclusions There is lack of consensus regarding the post-clipping imaging strategy in the Netherlands. Since intraoperative assessment is shown to be insufficient to predict postoperative aneurysm residuals, we advocate routine postoperative imaging after aneurysm clipping unless this is not warranted on the basis of patient age, clinical condition, and/or comorbidity. |
| Databáze: | OpenAIRE |
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