A Comparative Analysis Between Intraoperative Fluorescein Sodium Videoangiography and Postoperative Imaging for Evaluating Clipped Intracranial Aneurysms

Comparing the findings of intraoperative fluorescein sodium videoangiography (FL-VA) and post operative Computed Tomography Angiography (CTA), this study aims to assess whether FL-VA is a suitable modality for intraoperative evaluation of aneurysmal obliteration and the patency of parent and adjacent vessels. This study is an observational prospective analysis focused on patients who underwent surgery for aneurysms at the Department of Neurosurgery, Santa Casa BH, Belo Horizonte, Minas Gerais, from December 2021 to September 2022. Postoperative CTA was conducted in 54 patients (61 aneurysms). The results of the CTA revealed complete occlusion in 51 out of the 61 aneurysms, accounting for 83.6% of the cases. FL-VA revealed complete occlusion in 93.4% of the studied aneurysms (57 out of 61). Ten cases of discordance between FL-VA and CTA were identified: One patient was indicated as a neck remnant in FL-VA, but CT angiography revealed a residual aneurysm; one patient CT angiography showed neck remnant and stenosis in branching vessels, that it was not identified by FL-VA; five aneurysms had neck remnants, and three cases had stenosis in branching vessels, which were not observed in FL-VA but were detected in CTA. No studied factor showed significant association with the discordance observed between FL-VA and CT angiography. The results of this study contribute to the increasing evidence that supports FL-VA as a highly valuable modality for the intraoperative assessment of aneurysmal obliteration and the patency of parent and adjacent vessels