Wrapping of Intracranial Aneurysms with Gauze Sponge

Morioka, Motohiro; Marubayashi, Toru; Masumitsu, Tsutomu; Hori, Tetsuro; Ushio, Yukitaka

doi:10.2176/nmc.31.135

Cited by 11 publications

(3 citation statements)

References 22 publications

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“…Wrapping was considered an effective and safe treatment of these aneurysms, with a low mortality and morbidity. Morioka et al . (1991) compared 78 patients with aneurysms treated by gauze wrapping with 271 patients treated with clipping alone.…”

Section: Discussionmentioning

confidence: 99%

Progressive visual loss due to a muslinoma – report of a case and review of the literature

Berger¹,

Hartmann

Wildemann³

2003

Euro J of Neurology

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Intracranial internal carotid artery (ICA) aneurysms are frequently treated either by microsurgical clipping of the aneurysm neck, by endovascular coiling of the aneurysm sac or by balloon occlusion of the parent vessel. For some broad-based aneurysms that may not be suitable for any of these options, microsurgical wrapping of the aneurysm wall with muslin or gauze rarely is applied. We report the case of a patient who suffered from a minor stroke because of arterio-arterial embolism from an intracranial ICA aneurysm. The aneurysm was treated by wrapping muslin material. After 12 months, he experienced progressive visual loss. Cranial magnetic resonance testing magnetic resonance tomography (MRT) revealed a granulomatous inflammation surrounding the site of the aneurysm and affecting optochiasmatic structures. A muslin-induced optic neuropathy is a rare but serious complication of a chronic inflammatory reaction in response to muslin or gauze used in intracranial aneurysm wrapping. If the foreign body inflammatory reaction to muslin or gauze leads to a mass formation, the term muslinoma or gauzoma is applied. Various treatment strategies include surgery, steroids and cyclophosphamide, but recovery of the vision is not predictable. As a consequence, muslin or cotton gauze should only be applied with great caution in neurovascular surgery.

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Section: Discussionmentioning

confidence: 99%

Progressive visual loss due to a muslinoma – report of a case and review of the literature

Berger¹,

Hartmann

Wildemann³

2003

Euro J of Neurology

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“…19,20,24,31,50 Reinforcement of the residual neck and abnormal arterial wall is thought to lower the incidence of aneurysm recurrence. 19,20,31,54 Several previous reports indicate that aneurysms can recur from residual aneurysm fragments, and even from apparently well-clipped aneurysms, 14,32,47,68,69 and early reports stress the value of microsurgical reinforcement of incompletely obliterated aneurysm walls.…”

Section: 68mentioning

confidence: 99%

Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

Safavi–Abbasi

Moron²,

Sun

et al. 2016

JNS

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obJective To address the challenges of microsurgically treating broad-based, frail, and otherwise complex aneurysms that are not amenable to direct clipping, alternative techniques have been developed. One such technique is to use cotton to augment clipping ("cotton-clipping" technique), which is also used to manage intraoperative aneurysm neck rupture, and another is to reinforce unclippable segments or remnants of aneurysm necks with cotton ("cottonaugmentation" technique). This study reviews the natural history of patients with aneurysms treated with cotton-clipping and cotton-augmentation techniques. methods The authors queried a database consisting of all patients with aneurysms treated at Barrow Neurological Institute in Phoenix, Arizona, between January 1, 2004, and December 31, 2014, to identify cases in which cotton-clipping or cotton-augmentation strategies had been used. Management was categorized as the cotton-clipping technique if cotton was used within the blades of the aneurysm clip and as the cotton-clipping technique if cotton was used to reinforce aneurysms or portions of the aneurysm that were unclippable due to the presence of perforators, atherosclerosis, or residual aneurysms. Data were reviewed to assess patient outcomes and annual rates of aneurysm recurrence or hemorrhage after the initial procedures were performed. results The authors identified 60 aneurysms treated with these techniques in 57 patients (18 patients with ruptured aneurysms and 39 patients with unruptured aneurysms) whose mean age was 53.1 years (median 55 years; range 24-72 years). Twenty-three aneurysms (11 cases of subarachnoid hemorrhage) were treated using cotton-clipping and 37 with cotton-augmentation techniques (7 cases of subarachnoid hemorrhage). In total, 18 patients presented with subarachnoid hemorrhage. The mean Glasgow Outcome Scale (GOS) score at the time of discharge was 4.4. At a mean follow-up of 60.9 ± 35.6 months (median 70 months; range 10-126 months), the mean GOS score at last follow-up was 4.8. The total number of patient follow-up years was 289.4. During the follow-up period, none of the cotton-clipped aneurysms increased in size, changed in configuration, or rebled. None of the patients experienced early rebleeding. The annual hemorrhage rate for aneurysms treated with cotton-augmentation was 0.52% and the recurrence rate was 1.03% per year. For all patients in the study, the overall risk of hemorrhage was 0.35% per year and the annual recurrence rate was 0.69%. coNclusioNs Cotton-clipping is an effective and durable treatment strategy for intraoperative aneurysm rupture and for management of broad-based aneurysms. Cotton-augmentation can be safely used to manage unclippable or partially clipped intracranial aneurysms and affords protection from early aneurysm re-rupture and a relatively low rate of late rehemorrhage.

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“…It is known to produce a dense fibrotic reaction, thus strengthening fragile vessel walls. 15 However, like other surgical materials, muslin can cause various inflammatory reactions. In addition to muslin gauze, coating adhesives are applied to adhere the gauze to the vessel and prevent regrowth or rupture of clipped aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Muslinoma and muslin-induced foreign body inflammatory reactions after surgical clipping and wrapping for intracranial aneurysms: imaging findings and clinical features

Yoon¹,

Kim²,

Bae-Ju³

et al. 2010

JNS

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Wrapping of Intracranial Aneurysms with Gauze Sponge

Cited by 11 publications

References 22 publications

Progressive visual loss due to a muslinoma – report of a case and review of the literature

Progressive visual loss due to a muslinoma – report of a case and review of the literature

Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

Muslinoma and muslin-induced foreign body inflammatory reactions after surgical clipping and wrapping for intracranial aneurysms: imaging findings and clinical features

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