Per-operative angiography--a useful tool in cerebral aneurysm surgery?

The value of per-operative angiography in elective surgery for aneurysms in the anterior cerebral circulation is evaluated. A progressive decrease in the number of difficulties was observed and was correlated with the introduction and refinements of microsurgery. From 1980-1983 approximately 5-8% of the angiograms revealed technical details which, as elucidated in the Discussion, did not always seem to require surgical correction. No case of an aneurysm neck remaining patent was encountered during this period. Similarly, main arterial branches were found to be occluded on only a few occasions, whereas significant unoccluded remnants of the base of the aneurysm occurred in roughly 5% of the cases despite modern microsurgery. It is felt by the authors that angiographic control of the operative result is no longer required in every aneurysm case because of the options for adequate visual control offered by the microtechnique. With this background it is concluded that, despite the optimal technical conditions available, per-operative angiography cannot be universally recommended in aneurysm surgery because of the inherent complexity of the procedure. Instead, post-operative angiography is more appropriate as a routine procedure for follow-up of a variety of selected cases in which visual control was unsatisfactory.