Document Detail

The clip-wrap technique in the treatment of intracranial unclippable aneurysms.
MedLine Citation:
PMID:  20339665     Owner:  NLM     Status:  MEDLINE    
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.
Eberval Gadelha Figueiredo; Luciano Foroni; Bernardo Assumpção de Monaco; Marcos Q T Gomes; Hugo Sterman Neto; Manoel Jacobsen Teixeira
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Arquivos de neuro-psiquiatria     Volume:  68     ISSN:  1678-4227     ISO Abbreviation:  Arq Neuropsiquiatr     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-03-26     Completed Date:  2010-10-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0125444     Medline TA:  Arq Neuropsiquiatr     Country:  Brazil    
Other Details:
Languages:  eng     Pagination:  115-8     Citation Subset:  IM    
Division of Neurological Surger, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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MeSH Terms
Aneurysm, Ruptured / surgery*
Intracranial Aneurysm / surgery*
Middle Aged
Neurosurgical Procedures / instrumentation,  methods*
Retrospective Studies
Treatment Outcome

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