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

Arquivos de Neuro-Psiquiatria

Eberval Gadelha Figueiredo²  Luciano Foroni¹  Bernardo Assumpção De Monaco¹  Marcos Q.t. Gomes¹  Hugo Sterman Neto¹  Manoel Jacobsen Teixeira¹ 

[1] ,University of São Paulo School of Medicine Division of Neurological SurgerSão Paulo SP ,Brazil

关键词: aneurysms;    clipping;    surgical treatment;    wrapping;    aneurismas;    tratamento cirúrgico;   

DOI  :  10.1590/S0004-282X2010000100024

来源: SciELO

【 摘 要 】

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.

【 授权许可】

CC BY   
 All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License