When patients are operated on for cerebral aneurysms, a parent artery or its branch may be inadvertently occluded by a clip or kink of the artery. Usually this operative complication results in serious neurological deficits and poor prognosis. It remains most important to carry out careful dissection of the aneurysms and related arteries with microsurgical technique. As an adjunct to the surgical technique, we examined the efficacy of intraoperative portable digital subtraction angiography

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... in preventing arterial occlusion during the clipping of aneurysms. Between February, 1985 and December, 1989 we operated on 132 patients with cerebral aneurysms. Fifty-one cases (Group 1) were treated in the period before portable DSA was available. After the introduction of portable DSA, 81 cases (Group 2) underwent definite therapy for aneurysms with routine intraoperative DSA following the clipping. Four patients of Group 1 (7.8%) were found to have arterial occlusion demonstrated by postoperative angiography, including one case of anterior communicating artery aneurysm, two cases of middle cerebral artery aneurysm and one of anterior cerebral artery aneurysm. In contrast, only one of the Group 2 patients (1.2%) suffered permanent occlusion of an artery. In three cases including two anterior communicating artery aneurysms and one middle cerebral artery aneurysm, intraoperative portable DSA revealed vascular occlusion immediately after the clipping procedure. The occlusion was released by reapplying clips, and the second DSA demonstrated patent arteries. Portable DSA was particularly useful in visualizing branches of the parent artery of the aneurysm when not all of the branches are identified in the operative field. Another advantage is that more natural blood flow can be observed without brain retraction because DSA was usually done after removal of the retractors. No complication related to the portable DSA was encountered. It is suggested that intraoperative portable DSA is an important adjunct to the safer treatment of cerebral aneurysms. Inadvertent occlusion of the arteries following clipping can be discovered and corrected before it causes permanent neurological deficits.