The clip-wrap technique in the treatment of intracranial unclippable aneurysms.

Abstract

UNLABELLED:

Fusiform and dolichoectatic aneurysms are challenging lesions to treat with direct clipping. Treatment of these aneurysms often requires alternative surgical strategies, including extracranial-intracranial bypass, wrapping, or clip-wrap techniques. Nonetheless, these alternatives methods of treatment have been underused and frequently overlooked.

OBJECTIVE:

To report a series of nine cases of otherwise untreatable aneurysms managed using the clip-wrap technique and discuss its surgical nuances.

METHOD:

In the last four years, 9 cases of ruptured aneurysms treated by the clip-wrap techniques were identified in the Division of Neurological Surgery, University of São Paulo, School of Medicine.

RESULTS:

The aneurysms were located at middle cerebral artery (2), anterior choroidal artery (1), anterior communicating artery (1), carotid ophthalmic (3), posterior cerebral artery (1) and posterior-inferior cerebellar artery (1). Three were dolichoectatic, 4 were unsuitable to complete surgical clipping because parent or efferent vessels arises from the aneurysm sac (1 MCA, 1 AcomA, 1 CO, 1 PICA aneurysms) and two, although ruptured aneurysms, were too small (<2mm) to be directly clipped. No early or late rebleeding was observed after 2 years mean follow-up. One patient deceased due to pulmonary tromboembolism.

CONCLUSION:

Clip-wrap techniques for the treatment of fusiform and otherwise unclippable aneurysms seem to be safe and it can be associated with a low rate of acute or delayed postoperative complications. It can prevent rebleeding and represents an improvement when compared with the natural history.

• Authors: Eberval Gadelha Figueiredo, Luciano Foroni, Bernardo Assumpção de Monaco, Marcos Q T Gomes, Hugo Sterman Neto, Manoel Jacobsen Teixeira
• Journal: Arquivos de neuro-psiquiatria (Arq Neuropsiquiatr) Vol. 68 Issue 1 Pg. 115-8 (Feb 2010) ISSN: 1678-4227 [Electronic] Germany
• PMID: 20339665 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aneurysm, Ruptured (surgery)
• Female
• Humans
• Intracranial Aneurysm (surgery)
• Male
• Middle Aged
• Neurosurgical Procedures (instrumentation, methods)
• Retrospective Studies
• Treatment Outcome