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.
Clipwrap alternative series#
OBJECTIVE: To report a series of nine cases of otherwise untreatable aneurysms managed using the clip-wrap technique and discuss its surgical nuances. Nonetheless, these alternatives methods of treatment have been underused and frequently overlooked.
Treatment of these aneurysms often requires alternative surgical strategies, including extracranial-intracranial bypass, wrapping, or clip-wrap techniques. IVDivision of Neurological Surger, University of São Paulo, School of Medicine, São Paulo SP, Brazil: Director and Chairmanįusiform and dolichoectatic aneurysms are challenging lesions to treat with direct clipping. IIIDivision of Neurological Surger, University of São Paulo, School of Medicine, São Paulo SP, Brazil: Coordinator of Skull Base Surgery IIDivision of Neurological Surger, University of São Paulo, School of Medicine, São Paulo SP, Brazil: Resident IDivision of Neurological Surger, University of São Paulo, School of Medicine, São Paulo SP, Brazil: Supervisor and Coordinator of Cerebrovascular Surgery Gomes III Hugo Sterman Neto II Manoel Jacobsen Teixeira IV Técnica de "clip-wrap" no tratamento de aneurismas rotos não clipáveisĮberval Gadelha Figueiredo I Luciano Foroni II Bernardo Assumpção de Monaco II Marcos Q.T. The clip-wrap technique in the treatment of intracranial unclippable aneurysms Ela previne ressangramanto e representa um avanço em relação à história natural destas lesões. CONCLUSÃO: A técnica descrita é segura e está associada com baixa incidência de complicações agudas ou tardias. Sangramento precoce ou tardio não foram observados, em um seguimento médio de 2 anos. Três eram lesões ectásicas, 4 não puderam ser completamente clipados devido a relação de aneurismas com vasos eferentes, aferentes ou perfurantes, e dois, apesar de rotos eram pequenos demais para serem clipados (<2,0 mm). Destes, 2 aneurismas eram de artéria cerebral media, 1 de artéria coroidéia anterior, 1 de artéria comunicante anterior, 3 de artéria oftálmica, 1 de artéria cerebral posterior e 1 de PICA. Destes, 9 eram de aneurismas não clipáveis tratados com a técnica de "clip-wrap". RESULTADOS: Revisão dos últimos quatro anos da casuística da Divisão de Clínica Neurocirúrgica do HCFMUSP mostrou que 384 casos eram de aneurismas rotos. OBJETIVO: Descrever retrospectivamente casuística de nove casos de aneurismas não clipáveis tratados com a técnicas de "clip-wrap" e discutir as nuances cirúrgicas.
Contudo o uso destas técnicas é frequentemente esquecido e negligenciado. It can prevent rebleeding and represents an improvement when compared with the natural history.Īneurysms clipping surgical treatment wrappingĪneurismas fusiformes são lesões de difícil tratamento e frequentemente necessitam de técnicas alternativas de tratamento, incluindo anastomose extra-intracranial ou técnicas de "clip-wrap". 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. One patient deceased due to pulmonary tromboembolism. No early or late rebleeding was observed after 2 years mean follow-up. 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. 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). Fusiform and dolichoectatic aneurysms are challenging lesions to treat with direct clipping.
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