Use of Per-Operative Angiogram and Doppler Ultrasound as an Adjunct to Assess the Cerebral Vessels Following Aneurysmal Brain Surgery

Article Information

Title: Use of Per-Operative Angiogram and Doppler Ultrasound as an Adjunct to Assess the Cerebral Vessels Following Aneurysmal Brain Surgery

Authors: Awais Ali Khan, Habib Ullah Khan, Khurshid Ali Bangash, Shahzad Ahmed Qasmi, Syed Adeel Ahmed, Asif Hashmat, Babar Shamim

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2023

Volume: 73

Issue: 5

Language: English

DOI: 10.51253/pafmj.v73i5.8979

Keywords: AneurysmCerebral angiogram Ultrasonography doppler

Abstract

Objective: To study the efficacy of per-operative angiogram and Doppler ultrasound as an adjunct to assess the cerebral vessels during intracranial aneurysm clipping surgery.
Study Design: Cross-sectional study
Place and Duration of Study: Department of Neurosurgery, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2020 to Dec 2021.
Methodology: Forty-eight diagnosed cases of subarachnoid haemorrhage secondary to ruptured aneurysm were included. All the patients who were not coiled-able (broad-based, multi-lobed, complex) were operated on (craniotomy and clipping of aneurysm). Intraoperative angiogram and Doppler ultrasound of cerebral vasculature were done in all cases to see the patency of vessels and the position of clips.
Results: Mean age of the patients was 43.97±8.23 years. 24(50.00%) patients had anterior communicating artery aneurysms, 18(37.50%) had middle cerebral artery aneurysms, whereas 6(12.50%) were of an anterior cerebral artery. Craniotomy and clipping of aneurysm were done in all the cases; among them, 15(31.25%) were operated on early (between 48-96 hrs), whereas 33(68.75%) were operated on after 10-14 days. Per-operatively, cerebral angiogram and Doppler ultrasound were used to assess the cerebral vasculature and position of the clip. About of 5(10.00%) required clip readjustment, 4(8.33%) had parent vessel occlusion, 10(20.83%) required vasodilator therapy due to vasospasm, and 4(8.33%) had residual aneurysm neck. All these were rectified during the same procedure.
Conclusion: Per-operative angiography and Doppler ultrasound are useful adjuncts in aneurysmal brain surgery to prevent complications like cerebral ischemia, recurrence, residual aneurysm and re-bleed.

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Research Objective

To study the efficacy of per-operative angiogram and Doppler ultrasound as an adjunct to assess the cerebral vessels during intracranial aneurysm clipping surgery.

Methodology

Cross-sectional study involving 48 diagnosed cases of subarachnoid hemorrhage secondary to ruptured aneurysm. Patients underwent craniotomy and clipping of the aneurysm. Intraoperative angiogram and Doppler ultrasound of cerebral vasculature were performed to assess vessel patency and clip position.

Methodology Flowchart

                        graph TD;
    A["Diagnosed cases of subarachnoid haemorrhage secondary to ruptured aneurysm"] --> B["Craniotomy and clipping of aneurysm"];
    B --> C["Intraoperative angiogram and Doppler ultrasound"];
    C --> D["Assess vessel patency and clip position"];
    D --> E["Identify complications"];
    E -- Clip readjustment --> F["Rectify"];
    E -- Parent vessel occlusion --> F;
    E -- Vasospasm --> G["Vasodilator therapy"];
    G --> F;
    E -- Residual aneurysm neck --> F;
    F --> H["Conclusion on efficacy of adjuncts"];

Discussion

Per-operative angiography and Doppler ultrasound are valuable adjuncts in aneurysmal brain surgery, aiding in the prevention of complications such as cerebral ischemia, recurrence, residual aneurysm, and re-bleeding by confirming clip placement and blood flow. The timing of surgery (early vs. late) is also discussed in relation to vasospasm and surgical outcomes.

Key Findings

* 5 (10.00%) patients required clip readjustment.
* 4 (8.33%) patients had parent vessel occlusion.
* 10 (20.83%) patients required vasodilator therapy due to vasospasm.
* 4 (8.33%) patients had residual aneurysm neck.
* All identified issues were rectified during the same procedure.

Conclusion

Per-operative angiography and Doppler ultrasound are useful adjuncts in aneurysmal brain surgery to prevent complications like cerebral ischemia, recurrence, residual aneurysm, and re-bleed.

Fact Check

* The study included 48 patients.
* The mean age of the patients was 43.97±8.23 years.
* 10 (20.83%) patients required vasodilator therapy due to vasospasm.

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