gms | German Medical Science

Objective: Few cerebral aneurysms are not completely clippable or even unclippable due to small size and/or difficult morphology. In some cases, the aneurysm can be clipped partially and the remnant is wrapped with muscle, cotton and glue (clip-wrapping), or, the aneurysm is wrapped solely. In this study we aimed to assess the clinical and radiological outcomes of patients with aneurysms wrapped or clip-wrapped in our department over more than 20 years.

Methods: This retrospective study included 51 patients (39 women, 6 men; mean age 63 years) between 1993 and 2019. We reviewed pre- and postoperative charts, surgical reports, wrapping technique, and radiographic data for demographics, co-morbidities, radiographic features, Neurological Performance Scale (MRC) and the Karnofsky Performance Index (KPI).

Results: 47 (94%) of those aneurysms were located in the anterior circulation, and 22 patients (44%) presented with subarachnoid hemorrhage . Most frequently, wrapping was performed with autologous muscle or cotton, additionally fixed with fibrin glue.15 aneurysms were fusiform (30%), 14 aneurysms incorporated a bifurcation. 41 aneurysms were wrapped (82%), and 9 (18%) were clip-wrapped. At discharge the MRC score was 0 in 41 patients (82%), 1 in 7 patients (14%), and one patient died. The mean follow-up was 4.8 years (range, 2–19 y). 2 patients (1%) experienced further SAH from a wrapped aneurysm during follow-up. Due to the available radiographic data, we did not detect any change in size or morphology of a wrapped or clip-wrapped aneurysm.

Conclusion: Wrapping or clip-wrapping of small and/or fusiform intracranial aneurysms is rare but it seemingly provides protection against aneurysmal growth or (re-)rupture.

On the one hand, our data support the feasibility of wrapping and clip-wrapping in small and fusiform aneurysms, but on the other hand, the risks and benefits have to be compared to the natural course of this selected subgroup of vascular malformations.