Techniques and Outcomes of Gore-Tex Clip-Wrapping of Ruptured and Unruptured Cerebral Aneurysms

Sam Safavi-Abbasi, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Felix Moron, Department of Neurological Surgery, HIGA Vicente Lopez y Planes Gral Rodriguez, Buenos Aires, Argentina.
Hai Sun, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Christopher Wilson, Department of Neurological Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA.
Ben Frock, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Mark E. Oppenlander, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
David S. Xu, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Cameron Ghafil, Department of Neurological Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA.
Joseph M. Zabramski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Robert F. Spetzler, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Peter Nakaji, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@dignityhealth.org.

Document Type

Article

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. We report 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: Gore-Tex clip-wrapping was used in 8 patients with ruptured aneurysms and 22 patients with unruptured aneurysms. Aneurysms included 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 years). Postoperatively, there were no deaths or worsening of neurologic status and no parent vessel stenoses or strokes. The mean Glasgow Outcome Scale score at last follow-up was 4.7. The mean follow-up time was 42.3 months (median, 37.0 months; range, 3-96 months). There were 105.8 patient follow-up years. Aneurysms recurred in 2 patients with Gore-Tex clip-wrapping. 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 a 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.

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured (diagnostic imaging, surgery); Bandages; Equipment Design; Equipment Failure Analysis; Female; Humans; Intracranial Aneurysm (diagnostic imaging, surgery); Male; Middle Aged; Neurosurgical Procedures (instrumentation, methods); Retrospective Studies; Treatment Outcome; Young Adult

Publication Date

6-1-2016

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

90

First Page

281

Last Page

290

PubMed ID

26960285

Digital Object Identifier (DOI)

10.1016/j.wneu.2016.02.109

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