Granuloma formation and arterial thrombosis following cotton wrapping of an intracranial aneurysm a case report

Gianetti, Alexandre Varella; Perpétuo, Francisco Otaviano Lima

doi:10.1590/s0004-282x1992000400021

Cited by 12 publications

(1 citation statement)

References 11 publications

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“…Even in giant aneurysms, which are frequently characterised by partial luminal thrombosis [30], a complete spontaneous thrombotic occlusion of the aneurysmal lumen is rare [12]. After cotton wrapping of an aneurysm of the MCA trifurcation, a single example of thrombosis of the aneurysm and the whole MCA has been reported [13]. In this patient, the formation of a granuloma was also observed.…”

Section: Discussionmentioning

confidence: 78%

Granuloma formation and occlusion of an unruptured aneurysm after wrapping

Andres

Guzman

Weis

et al. 2007

Acta Neurochir (Wien)

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Excessive granulomatous foreign-body reaction is a very rare complication after wrapping of intracranial aneurysms. The pathogenetic mechanisms underlying this process are unknown. We report on a patient who developed a space-occupying granulomatous abscess after wrapping of an unruptured aneurysm of the M2/M3 bifurcation. The patient underwent revision craniotomy for abscess removal. The aneurysm was explored and found to be completely thrombosed and excluded from the circulation. Exuberant granulomatous foreign-body reaction was pathologically confirmed and Candida parapsilosis was isolated from the pus. The patient underwent an antifungal treatment regimen and recovered with no residual neurological deficits. Our findings support the assumption that a low-grade infectious process might trigger excessive inflammatory reaction after wrapping. We suggest that this process may also result in complete thrombosis of cerebral aneurysms, which is otherwise a rarely observed phenomenon.

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Section: Discussionmentioning

confidence: 78%

Granuloma formation and occlusion of an unruptured aneurysm after wrapping

Andres

Guzman

Weis

et al. 2007

Acta Neurochir (Wien)

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Wrapping of Solitary Ruptured Intracranial Aneurysms, Outcome at Five Years

Cudlip

Kitchen

McKhahn

et al. 1998

Acta Neurochirurgica

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Previous follow up studies of patients who have had ruptured intracranial aneurysms treated by a wrapping technique have largely been in the pre-microsurgical era. Our objective was to ascertain whether wrapping aneurysms with the aid of the operating microscope provides protection against rebleeding in the short and long term. The study involved retrospective analysis of patients with ruptured aneurysms treated by wrapping over a six-year period. Twenty-nine patients were identified with wrapped aneurysms, of these 15 had wrapping of a solitary ruptured aneurysm, the remainder were excluded because of clip/wrap combination, multiple aneurysms, and unruptured aneurysms. Of the 15 patients who had a solitary ruptured aneurysm wrapped, none had rebled at one year follow up. One patient died of a myocardial infarction at 4 years, the remaining 14 patients had no episodes of rebleeding with all patients achieving Glasgow outcome scores of four or five at 5 years follow-up. Although surgical clipping of intracranial aneurysms is the definitive method of treatment, our findings suggest that wrapping of ruptured intracranial aneurysms with the aid of the operating microscope confers good protection against both early and late rebleeding in those cases considered 'unclippable'.

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Long-term follow-up of ruptured intracranial aneurysms treated by microsurgical wrapping with autologous muscle

et al. 2012

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The purpose of this study is to describe our series of nine unclippable and uncoilable ruptured aneurysms in eight patients treated by microsurgical wrapping with autologous muscle. Records were retrospectively reviewed for rebleeding rate, morbidity and mortality, changes in size or the aneurysm's configurations, and inflammatory reaction. We conducted a Medline search in the post-microsurgical era, excluding patients in whom wrapping was part of the aneurysm treatment in combination with clipping or coiling. The surgically related morbidity was 12.5%. Global mortality rate was 25% due to vasospasm (one case) and rebleeding (one case). Six patients are still alive. Rebleeding rate was 14.3% within 6 months; then, it was zero. Glasgow outcome scale (GOS) score at discharge was 1 and 4 in one patient, respectively, and 5 in the remaining six. Mean clinical follow-up was 126 months. GOS at last follow-up was 4 and 5 in 50% of patients, respectively. Mean mRS score was 0.8 at 2 months, and 2.4 at 12 months. Follow-up MR demonstrated persistence of the aneurysm's sac, without changes in size and configuration. Patients did not describe or exhibit symptoms attributable to complications inherent to the use of muscle. Microsurgical muscle-wrapping of ruptured intracranial aneurysm is safe, is associated with a low rate of acute and delayed postoperative complications and rebleeding, and could be a valid alternative for unclippable and non-amenable to endovascular procedure ruptured aneurysms.

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Granuloma formation and arterial thrombosis following cotton wrapping of an intracranial aneurysm a case report

Cited by 12 publications

References 11 publications

Granuloma formation and occlusion of an unruptured aneurysm after wrapping

Granuloma formation and occlusion of an unruptured aneurysm after wrapping

Wrapping of Solitary Ruptured Intracranial Aneurysms, Outcome at Five Years

Long-term follow-up of ruptured intracranial aneurysms treated by microsurgical wrapping with autologous muscle

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