Wrapping of Solitary Ruptured Intracranial Aneurysms, Outcome at Five Years

Abstract

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'.

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

“…Several studies showed that the wrapping technique was as effective as clip ligation to aneurysm treatment on longterm follow up 3,4,14) . A number of materials have been used to treat aneurysms : muslin gauze 10,17) , surgicel, muscle 5,14) , biobond adhesive, and histoacryl adhesive 2) .…”

“…However, when clipping or coiling is impossible, neurosurgeons have to decide on another treatment such as wrapping or aneurysm neck remodeling 6) . 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 clip-wrap technique in the treatment of intracranial unclippable aneurysms

“…Cudlip et al 5 presented 15 patients with a solitary ruptured aneurysm treated by wrapping. No patients had rehemorrhaged after one year of follow-up.…”

Aneurysmal Subarachnoid Hemorrhage

“…This technique consists in wrapping the aneurysm and the parent artery by surgical gauze or plastic sheeting in order to prevent further rebleeding [61]. Finally, bypass associated with parent artery sacrifice may be an option for the treatment of some very complex IC aneurysms, especially for giant/large aneurysms of the MCA [62].…”