Operation of the Thin Walled Aneurysms

Summary: Coagulation, coating and wrapping have been adapted as treatments for small cerebral aneurysms among unclippable aneurysm cases, and each brain surgeon decides which method to choose. A strategic method of surgical treatment is required, especially in cases of blood blister-like aneurysms found at the internal carotid artery. Although the methods of wrapping clipping and trapping plus bypass are reported, these are not standard treatments.We have adapted the wrapping-clipping method using Dacron tape to reinforce after coating and coagulation for cerebral small aneurysms 2-3 mm in diameter. In this method, the cerebral aneurysms as well as the parent artery are wrapped and then clipped at both ends with Dacron tape. We report 5 cases using this procedure: 4 SAH cases and 1 unruptured aneurysm. Three cases were considered as blood blister-like aneurysms. We used Dacron tape to reinforce after clipping in the SAH cases and after coating in the unruptured case.The results from the 4 cases in follow-ups averaging 4 years were good. Dacron tape is excellent operatively; it is reliable as reinforcement material for blood vessels and is useful for unclippable cerebral small aneurysms. In addition, it is also available for blood blister-like aneurysms because we can expect obliteration to maintain good antegrade blood flow.It is necessary to decide the strategic method of surgical treatment preoperatively. Key words:intracranial aneurysm reinforcement wrapping blister-like aneurysm Surg Cereb Stroke

Wrapping-clipping with Dacron Tape for Small Cerebral Aneurysms.

Matsuzaki¹,

Shimazaki²,

Satoh³

et al. 2001

A Case of Giant IC-PC Unruptured Aneurysm with Intraoperative Rupture at the Neck

Yokoyama¹,

Miyamoto²,

Kim³

et al. 2004

Internal Carotid Aneurysm with Circumferential Dilatation

Fujioka¹,

Nishi²,

Koga³

et al. 2006

Summary:We present 3 cases of ruptured aneurysms with circumferential dilatation of the internal carotid artery (IC). Two of the cases presented repeated hemorrhage following neck clipping of the berry aneurysms arising from the anterior wall of IC. In the second surgery, it was confirmed that the newly formed aneurysm extended circumferentially from the primary aneurysm, which had been obliterated completely in the initial surgery.Case 1 died of rerupture of the aneurysm following the second fundus-wrapping surgery. In Case 2, the aneurysm was obliterated safely using a fenestrated clip in the second surgery. Case 3 with subarachnoid hemorrhage underwent craniotomy because of progressive dilatation of C2 segment.Intraoperatively multiple blister-like bulging spots were identified on the surface of circumferentially dilated IC. It was repaired by so-called clipping on wrapping method. In the surgery, the clip produced mild narrowing of IC in spite of careful application of the clip to avoid kink. This finding suggested that this type of aneurysm was formed by a special mechanism such as arterial dissection.We stress the necessity of close postoperative observation even if neck obliteration seems to have been complete in the IC anterior wall aneurysm. Furthermore we recommend extraordinary procedures such as a combination of trapping and bypass surgery or the so-called clipping on wrapping method in this type of aneurysm.