Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical and Angiographic Results after Treatment with Combined Clipping and Wrapping Technique for Intracranial Aneurysm

  • Suh, Sang-Jun (Department of Neurosurgery, Daegu Fatima Hospital) ;
  • Kim, Sang-Chul (Department of Neurosurgery, Daegu Fatima Hospital) ;
  • Kang, Dong-Gee (Department of Neurosurgery, Daegu Fatima Hospital) ;
  • Ryu, Kee-Young (Department of Neurosurgery, Daegu Fatima Hospital) ;
  • Lee, Hyuk-Gee (Department of Neurosurgery, Daegu Fatima Hospital) ;
  • Cho, Jae-Hoon (Department of Neurosurgery, Kosin University Gospel Hospital)
  • Published : 2008.10.28
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Abstract

Objective : There have been numerous follow-up studies of patients who had ruptured or unruptured intracranial aneurysms treated by wrapping technique using various materials have been reported. Our objective was to ascertain whether our particular wrapping technique using the temporalis muscle provides protection from rebleeding and any aneurysm configuration changes in follow-up studies. Methods : Clinical presentation, the location and shape of the aneurysm, outcomes at discharge and last follow-up, and any aneurysm configuration changes on last angiographic study were analyzed retrospectively in 21 patients. Reinforcement was acquired by clipping the wrapped temporalis muscle. Wrapping and clipping after incomplete clipping was also done. Follow-up loss and non-angiographic follow-up patient groups were excluded in this study. Results : The mean age was 53 years (range 29-67), and 15 patients were female. Among 21 patients, 10 patients had ruptured aneurysms (48%). Aneurysms in 21 patients were located in the anterior circulation. Aneurysm shapes were broad neck form (14 cases), fusiform (1 case), and bleb to adjacent vessel (6 cases). Five patients were treated by clipping the wrapped temporalis, and 16 patients by wrapping after partial clipping. The mean Glasgow coma scale (GCS) at admission was 14.2. The mean Glasgow outcome scale (GOS) at discharge was 4.8, and 18 patients were grade 5. The mean period between initial angiography and last angiography was 18.5 months (range 8-44). Aneurysm size was not increased in any of these patients and configuration also did not change. There was no evidence of rebleeding in any of these treated aneurysms. Conclusion : Our study results show that wrapping technique, using the temporalis muscle and aneurysm clip(s), for intracranial aneurysm treatment provides protection from rebleeding or regrowth.

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References

  1. Carney PG, Oatey PE : Muslin wrapping of aneurysms and delayed visual failure. A report of three cases. J Clin Neuroophthalmol 3 : 91-96, 1983
  2. Cossu M, Pau A, Turtas S, Viola C, Viale GL : Subsequent bleeding from ruptured intracranial aneurysms treated by wrapping or coating : a review of the long-term results in 47 cases. J Neurosurg 32 : 344-346; discussion 347, 1993 https://doi.org/10.1227/00006123-199303000-00002
  3. Cudlip SA, Kitchen ND, McKhahn GM, Bell BA : Wrapping of solitary ruptured intracranial aneurysms, outcome at five years. Acta Neurochir (Wien) 140 : 1167-1170; discussion 1170-1171, 1998 https://doi.org/10.1007/s007010050232
  4. Deshmukh VR, Kakarla UK, Figueiredo EG, Zabramski JM, Spetzler RF : Long-term clinical and angiographic follow-up of unclippable wrapped intracranial aneurysms. J Neurosurg 58 : 434-442; discussion 434-442, 2006 https://doi.org/10.1227/01.NEU.0000199158.02619.99
  5. Dott N : Intracranial aneurysms, cerebral arterio-radiography surgical treatment. Edinb Med J 40 : 219-234, 1933
  6. Ebina K, Iwabuchi T, Suzuki S : A clinico-experimental study on various wrapping materials of cerebral aneurysms. Acta Neurochir (Wien) 72 : 61-71, 1984 https://doi.org/10.1007/BF01406814
  7. Fujiwara S, Fujii K, Nishio S, Fukui M : Long-term results of wrapping of intracranial ruptured aneurysms. Acta Neurochir (Wien) 103 : 27-29, 1990 https://doi.org/10.1007/BF01420188
  8. Haisa T, Matsumiya K, Yoshimasu N, Kuribayashi N : Foreignbody granuloma as a complication of wrapping and coating an intracranial aneurysm. Case report. J Neurosurg 72 : 292-294, 1990 https://doi.org/10.3171/jns.1990.72.2.0292
  9. Herrera O, Kawamura S, Yasui N, Yoshida Y : Histological changes in the rat common carotid artery induced by aneurysmal wrapping and coating materials. Neurol Med Chir (Tokyo) 39 : 134-139; discussion 139-140, 1999 https://doi.org/10.2176/nmc.39.134
  10. Kirollos RW, Tyagi AK, Marks PV, van Hille PT : Muslin induced granuloma following wrapping of intracranial aneurysms : the role of infection as an additional precipitating factor. Report of two cases and review of the literature. Acta Neurochir (Wien) 139 : 411-415, 1997 https://doi.org/10.1007/BF01808876
  11. Minakawa T, Koike T, Fujii Y, Ishii R, Tanaka R, Arai H : Long term results of ruptured aneurysms treated by coating. Neurosurgery 21 : 660-663, 1987 https://doi.org/10.1227/00006123-198711000-00010
  12. Mount LA, Antunes JL : Results of treatment of intracranial aneurysms by wrapping and coating. J Neurosurg 42 : 189-193, 1975 https://doi.org/10.3171/jns.1975.42.2.0189
  13. Onoue H, Abe T, Tashibu K, Suzuki T : Two undesirable results of wrapping of an intracranial aneurysm. Neurosurg Rev 15 : 307-309, 1992
  14. Sachs E Jr : The fate of muscle and cotton wrapped about intracranial carotid arteries and aneurysms. A laboratory and clinico-pathological study. Acta Neurochir (Wien) 26 : 121-137, 1972 https://doi.org/10.1007/BF01406549
  15. Sato K, Fujiwara S, Kameyama M, Ogawa A, Yoshimoto T, Suzuki J : Follow-up study on ruptured aneurysms treated by wrapping. Neurol Med Chir (Tokyo) 30 : 734-737, 1990 https://doi.org/10.2176/nmc.30.734
  16. Taylor JC, Choudhury AR : Reinforcement with gauze wrapping for ruptured aneurysms of the middle cerebral artery. J Neurosurg 47 : 828-832, 1977 https://doi.org/10.3171/jns.1977.47.6.0828
  17. Todd NV, Tocher JL, Jones PA, Miller JD : Outcome following aneurysm wrapping : a 10-year follow-up review of clipped and wrapped aneurysms. J Neurosurg 70 : 841-846, 1989 https://doi.org/10.3171/jns.1989.70.6.0841