We chose a segment slightly longer than the length of the fusiform aneurysm in order to avoid pre- and post-wrap-clipping stenosis. While the firm attachment between the inferior falx and the fusiform aneurysm was maintained, a section of the lower thinner part of the falx cerebri firmly attached to the aneurysm was dissected and wrapped around the fusiform aneurysm, stabilized with a fenestrated clip. We present a review of the literature with an illustrative case, with a ruptured fusiform pericallosal artery aneurysm firmly attached to the lower edge of the falx cerebri and not amenable to endovascular intervention. However, there is no available literature on use of the falx cerebri for wrap-clipping. Various techniques have been used for wrap-clipping a ruptured, fusiform intracranial aneurysm. It is suggested that COCW is a treatment that enables safe and long-term management of lesions in IC-BLAs. As the final outcome, the numbers of patients with a Modified Rankin Score of 0, 3, and 6 were 13, 1, and 1, respectively. No complications or regrowth of an aneurysm were observed in the remaining 14 patients during the follow-up period, except for 1 patient who received a reoperation for the regrowth of an aneurysm. The first patient experienced rerupture of an aneurysm 10 days after the operation. The long-term outcome of the treatment was analyzed. All 15 patients were treated with COCW, except for the first patient, who was treated using a single strip of cotton. Here we report the technical details of this method and the long-term outcomes of patients receiving this procedure.ДЇifteen of 1275 (1.5%) patients with a ruptured cerebral aneurysm who received treatment at the Saiseikai Kumamoto Hospital during the period from January 1, 1999, to December 31, 2016, had an IC-BLA. This method is reliable in preventing the clips from slipping off and the aneurysm walls from being damaged during clipping, and it enables more appropriate and safer clipping. We have been performing the clipping on crossed wrapping (COCW) method using 2 strips of cotton on patients with an internal carotid artery blood blister-like aneurysm (IC-BLA). This study may thus contribute to the debate on the optimal treatment strategy for BBA. Five patients with WFNS SAH score 4 or 5 achieved favorable outcomes.Д®arly double bypass technique guided by MCABP measurement and combined with trapping (or rarely clipping) seems to be a safe method with excellent long-term outcomes in patients in PINC. There were 2 premature intraoperative ruptures, but no perioperative mortality, aneurysm recurrence, or rebleeding. Although angiographic vasospasms were not observed in our patients, two of them experienced cerebral infarction, attributable more to the mass effect and postoperative ICA thrombosis than to SAH-induced vasospasm. By contrast, only a minimal drop in MCABP following ICA clamping was detected in two cases, although their collaterals were slim/nonvisualized on imaging.

No pulse pressure in the MCA after internal carotid artery (ICA) clamping was found in 3 patients, although their ACoA or PCoA were well visualized on preoperative angiograms. Seven patients presented with World Federation of Neurosurgical Societies (WFNS) subarachnoid hemorrhage (SAH) score 4 or 5.

Intraoperative middle cerebral artery blood pressure (MCABP) measurement was used for selection of bypass procedure.

Retrospective analysis of clinical, radiological, and surgical data in 9 patients treated between January 2009 and December 2015. To analyze of benefit of double bypass technique to surgical outcomes in patients with ruptured BBA in poor initial neurological condition (PINC).

Some surgeons prefer clipping reconstruction while others favor primary bypass with trapping. Optimal surgical treatment of blood-blister aneurysms (BBA) remains controversial.

Clipwrap free