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Risk of rupture of previously “wrapped” intracranial aneurysms

Macquarie Neurosurgery

Evidence Based Surgery presentation

11th July, 2013

Peter Wilson

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Clinical case

• 60 year old lady• Smoker• Wrapping of unruptured complex calcified

MCA aneurysm 6 years ago• MCA infarct post-op

– Spastic hemiplegia

• Previously recommended 3 monthly CTAs

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Searchable question (PICO format)

• P = patients with previously wrapped intracranial aneurysms

• I = wrap• C = clipping• O = haemorrhage / rupture rate

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Search strategy

• Intracranial aneurysm• Wrap (or similar)

– Muslin– Gauze– Bandage– Mesh

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Search results

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Summary of papers

• Few large series• Risk of rupture greatest initially• ?similar to natural history in long term• Risk of local complications

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Conclusions

• Wrapping is not an ideal treatment strategy• “Unclippable” defined by treating surgeon

– ?small clips for aneurysms <3 mm– ?bypass alternatives