Wrapping of intracranial aneurysms: Single-center series and systematic review of the literature

Background. Circumferential wrapping of the aneurysm wall with a variety of materials is a well-known therapeutic approach for the repair of unclippable intracranial aneurysms (IAs). Wrapping materials can stimulate foreign-body inflammatory reactions and parent artery narrowing with resultant ische...

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Bibliographic Details
Published in:British journal of neurosurgery 2015-11, Vol.29 (6), p.785-791
Main Authors: Perrini, Paolo, Montemurro, Nicola, Caniglia, Michele, Lazzarotti, Guido, Benedetto, Nicola
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Aneurysm, Ruptured - surgery
Aneurysms
Bandages - adverse effects
Brain
Brain Ischemia - etiology
Brain Ischemia - therapy
Brain surgery
cerebrovascular complications
Cerebrovascular Disorders - etiology
Female
Glasgow Outcome Scale
Granuloma, Foreign-Body - etiology
Granuloma, Foreign-Body - therapy
Humans
intracranial aneurysm
Intracranial Aneurysm - surgery
Male
Microsurgery
Middle Aged
muslinoma
Neurosurgical Procedures - adverse effects
Neurosurgical Procedures - methods
Recurrence
Retrospective Studies
Stroke
Stroke - etiology
Systematic review
wrapping
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Summary:Background. Circumferential wrapping of the aneurysm wall with a variety of materials is a well-known therapeutic approach for the repair of unclippable intracranial aneurysms (IAs). Wrapping materials can stimulate foreign-body inflammatory reactions and parent artery narrowing with resultant ischemic stroke. In this study, a single-center retrospective review of the outcome with wrapping of IAs is presented beside an analysis of existing literature. Methods. For the institutional analysis, all patients who underwent wrapping of IAs in the last five years were analyzed. For the analysis of the literature, a MEDLINE search between 1990 and the present was performed for clinical series reporting wrapping of IAs. Specifically, the risk of rebleeding, cerebrovascular complications, and the incidence of granuloma formation were evaluated. Results. Two hundred and ninety patients with IA were surgically treated in our department. Fifteen patients (5.2%) underwent wrapping of IA. Early parent artery narrowing occurred in one patient (6.7%) and was associated with ischemic stroke. Delayed cerebrovascular complications, including parent artery narrowing (one case), granuloma formation (one case), and fatal bleeding from an unruptured aneurysm, occurred in three patients (20%). For the review of the literature, 197 cases of wrapped aneurysms were collected. Bleeding after wrapping occurred in 16 (12%) of the patients with ruptured aneurysms. Acute ischemic complications were reported in 7 cases (3.5%) and granuloma formation was observed in 3 patients (1.5%). Conclusions. These data suggest that the microsurgical wrapping of IAs present a risk of ischemic complications and granuloma formation. Additionally, the rebleeding rate of ruptured aneurysms remains high, although still lower than the natural history of untreated ruptured aneurysms
ISSN:0268-8697
1360-046X
DOI:10.3109/02688697.2015.1071320