Outcome following aneurysm wrapping: a 10-year follow-up review of clipped and wrapped aneurysms

Abstract

One hundred and eighty-one patients with single aneurysms involving the anterior circulation were treated either by wrapping (60 cases) or clipping (121 cases), and 96.1% of them were followed for 10 years. The rate of early rebleeding (less than 6 months) from wrapped aneurysms was 8.6% (confidence interval 1.4% to 15.8%) and the late rebleeding (6 months to 10 years) rate was 1.5% per annum (confidence interval 0.3% to 2.5%/yr). Wrapping an aneurysm offers some protection from rebleeding, particularly during the first 6 months when the risk of rebleeding is high.

Clinical and Angiographic Results after Treatment with Combined Clipping and Wrapping Technique for Intracranial Aneurysm

“…After the introduction of microsurgical technology, these studies showed that the rebleeding rate of wrapped aneurysms was generally low 4,16,17) , but these studies suggested that the wrapping technique was still less effective than clipping in preventing early rebleeding. Todd et al 17) reported that their early rebleeding rate (within the first 6 months) was 8.6%, and their late rate of rebleeding was 1.5% per year. Another study using biobond and histoacryl with gauze showed that the total rebleeding rate was about 10.5% (4/38) 2) .…”

“…Our wrap-and-clip technique or clip reinforcement wrapping technique using temporalis can be a favored method in unclippable aneurysm cases. In earlier studies, there was a degeneration and resorption of the wrapped temporlis muscle, and resulted in late rebleeding 2,17) . However, such cases have not been found in our hospital yet.…”

“…A number of materials have been used to treat aneurysms : muslin gauze 10,17) , surgicel, muscle 5,14) , biobond adhesive, and histoacryl adhesive 2) . In an early study, a high rebleeding rate was reported when biobond was used as a coating agent 11) .…”

“…Many authors had reported the efficacy of the wrapping technique, and the rebleeding and regrowth rates in wrapped aneurysms [2][3][4]7,11,15,17) . There have been numerous materials for wrapping have been used to reinforce the aneurysmal sac including muslin gauze 10,17) , surgicel, muscle 5,14) , biobond adhesive and histoacryl adhesive 2) , etc. The aim of this study was to share the results and efficacy of surgical wrapping or wrapping after the partial clipping of the aneurysmal sac with temporalis muscle in angiographic and clinical follow-up.…”

Ruptured Fusiform Aneurysm of the Proximal Anterior Cerebral Artery (A1 Segment) -Case Report-

“…31) The wrapping procedure is safe and durable, so can prevent aneurysmal growth or hemorrhage. However, wrapping has a re-rupture rate of 12-18%, 2,4,6,13,21,22,30) indicating insufficient safety and durability to prevent re-rupture and re-growth after treatment. Incomplete wrapping has resulted in many cases of re-rupture.…”