Marc Kotowski1, Behzad Farzin2, Robert Fahed3, François Guilbert2, Miguel Chagnon4, Tim E Darsaut5, Roy T Daniel6, Jean Raymond7. 1. Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Faculty of Biology and Medicine, Université de Lausanne, Lausanne, Switzerland. 2. Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada. 3. Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Interventional Neuroradiology Unit, Fondati Rothschild Hospital, Paris, France. 4. Department of Mathematics and Statistics, Université de Montréal, Montreal, Quebec, Canada. 5. University of Alberta Hospital, Mackenzie Health Sciences Centre, Division of Neurosurgery, Department of Surgery, Edmonton, Canada. 6. Faculty of Biology and Medicine, Université de Lausanne, Lausanne, Switzerland; Department of Clinical Neurosciences, Neurosurgery Unit, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland. 7. Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada. Electronic address: jean.raymond@umontreal.ca.
Abstract
OBJECTIVE: The surgical repair of a cerebral aneurysm does not always lead to complete occlusion. A standardized repeatable method of reporting results of surgical clipping is desirable. Our purpose was to systematically review methods of classifying aneurysm remnants, provide a new scale with precise definitions of categories, and perform an agreement study to assess the variability in adjudicating remnants after aneurysm clipping. METHODS: A systematic review was performed to identify ways to report angiographic results of surgical clipping between 1963 and 2017. Postclipping angiographic results of 43 patients were also independently evaluated by 10 raters of various experience and backgrounds using a new 4-category scale. Agreement between responses were analyzed using κ statistics. RESULTS: The systematic review yielded 63 articles with 37 different nomenclatures using 2-6 categories. The reliability of judging the presence of an aneurysm remnant on catheter angiography was studied only twice, with only 2 raters each time, with contradictory results. Interobserver agreement using the new 4-category scale was moderate (κ = 0.52; 95% confidence interval, 0.43-0.62) for all observers, but improved to substantial (κ = 0.62; 95% confidence interval, 0.47-0.76) when results were dichotomized (grade 0/1 vs. 2/3). CONCLUSIONS: Various classification schemes to evaluate angiographic results after surgical clipping exist in the literature, but they lack standardization. Adjudication using fewer, better defined categories may yield more reliable agreement.
OBJECTIVE: The surgical repair of a cerebral aneurysm does not always lead to complete occlusion. A standardized repeatable method of reporting results of surgical clipping is desirable. Our purpose was to systematically review methods of classifying aneurysm remnants, provide a new scale with precise definitions of categories, and perform an agreement study to assess the variability in adjudicating remnants after aneurysm clipping. METHODS: A systematic review was performed to identify ways to report angiographic results of surgical clipping between 1963 and 2017. Postclipping angiographic results of 43 patients were also independently evaluated by 10 raters of various experience and backgrounds using a new 4-category scale. Agreement between responses were analyzed using κ statistics. RESULTS: The systematic review yielded 63 articles with 37 different nomenclatures using 2-6 categories. The reliability of judging the presence of an aneurysm remnant on catheter angiography was studied only twice, with only 2 raters each time, with contradictory results. Interobserver agreement using the new 4-category scale was moderate (κ = 0.52; 95% confidence interval, 0.43-0.62) for all observers, but improved to substantial (κ = 0.62; 95% confidence interval, 0.47-0.76) when results were dichotomized (grade 0/1 vs. 2/3). CONCLUSIONS: Various classification schemes to evaluate angiographic results after surgical clipping exist in the literature, but they lack standardization. Adjudication using fewer, better defined categories may yield more reliable agreement.
Authors: Anass Benomar; Behzad Farzin; David Volders; Guylaine Gevry; Justine Zehr; Robert Fahed; William Boisseau; Jean-Christophe Gentric; Elsa Magro; Lorena Nico; Daniel Roy; Alain Weill; Charbel Mounayer; François Guilbert; Laurent Létourneau-Guillon; Gregory Jacquin; Chiraz Chaalala; Marc Kotowski; Thanh N Nguyen; David Kallmes; Phil White; Tim E Darsaut; Jean Raymond Journal: Neuroradiology Date: 2021-02-24 Impact factor: 2.804
Authors: A Benomar; B Farzin; G Gevry; W Boisseau; D Roy; A Weill; D Iancu; F Guilbert; L Létourneau-Guillon; G Jacquin; C Chaalala; M W Bojanowski; M Labidi; R Fahed; D Volders; T N Nguyen; J-C Gentric; E Magro; G Boulouis; G Forestier; J-F Hak; J S Ghostine; Z Kaderali; J J Shankar; M Kotowski; T E Darsaut; J Raymond Journal: AJNR Am J Neuroradiol Date: 2021-07-29 Impact factor: 4.966
Authors: Guilherme Brasileiro de Aguiar; Matheus Kohama Kormanski; Carolina Junqueira Tavares Corrêa; Andrew Vinícius de Souza Batista; Mario Luiz Marques Conti; José Carlos Esteves Veiga Journal: Clinics (Sao Paulo) Date: 2020-10-26 Impact factor: 2.365