Techniques and outcomes of Gore-Tex clip-wrapping of ruptured and unruptured cerebral aneurysms

• Published in: World neurosurgery Vol. 90; pp. 281 - 290
• Main Authors: Safavi-Abbasi, Sam, MD, PhD, Moron, Felix, MD, Sun, Hai, MD, PhD, Wilson, Christopher, BS, Frock, Ben, BA, Oppenlander, Mark E., MD, Xu, David S., MD, Ghafil, Cameron, BS, Zabramski, Joseph M., MD, Spetzler, Robert F., MD, Nakaji, Peter, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - surgery; Bandages; Cerebral aneurysm; Equipment Design; Equipment Failure Analysis; Female; Gore-Tex clip technique; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Male; Microsurgery; Microsurgical clipping; Middle Aged; Neurosurgery; Neurosurgical Procedures - instrumentation; Neurosurgical Procedures - methods; Retrospective Studies; Ruptured aneurysm; Subarachnoid hemorrhage; Treatment Outcome; Unruptured aneurysm; Young Adult; computed tomography; Cerebral aneurysm; Glasgow Outcome Scale; GOS; MCA; microsurgery; middle cerebral artery; CT; unruptured aneurysm; microsurgical clipping; subarachnoid hemorrhage; ruptured aneurysm; Gore-Tex clip technique; Subarachnoid hemorrhage; Unruptured aneurysm; Microsurgery; Microsurgical clipping; Ruptured aneurysm
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.02.109

Abstract Objective Some aneurysms without a definable neck and associated parent vessel pathology are particularly difficult to treat and may require clipping with circumferential wrapping. This is the largest available contemporary series examining the techniques of Gore-Tex clip-wrapping of ruptured and unruptured intracranial aneurysms and patient outcomes. Methods The presentation, location, and shape of the aneurysm; wrapping technique; outcome at discharge and last follow-up; and any change in the aneurysm at last angiographic follow-up were reviewed retrospectively in 30 patients with Gore-Tex clip-wrapped aneurysms. Results Eight patients with ruptured aneurysms and 22 patients with unruptured aneurysms were managed by Gore-Tex clip-wrapping. Patients had 23 fusiform, 3 blister, and 4 otherwise complex, multilobed, or giant aneurysms. Of the 30 aneurysms, 63% were in the anterior circulation. The overall mean patient age was 52.5 years (range, 17-80). Postoperatively, there were no deaths or worsening of neurologic status and no parent vessel stenoses or strokes. The mean Glasgow Outcomes Scale score at last follow-up was 4.7. The mean follow-up was 42.3 months (median, 37.0; range, 3-96months). There were a total of 105.8 patient follow-up years. Two patients with Gore-Tex clip-wrapping had aneurysm recurrence. No patients developed rehemorrhage. Overall risk of recurrence was 1.9% annually. Conclusions Gore-Tex has excellent material properties for circumferential wrapping of aneurysms and parent arteries. It is inert and does not cause tissue reaction or granuloma formation. Gore-Tex clip-wrapping can be used safely for microsurgical management of ruptured and unruptured cerebral aneurysms with acceptable recurrence and rehemorrhage rates.