ANEURYSM REINFORCEMENT IN THE ANTERIOR CIRCULATION

BACKGROUND Aneurysms are primarily treated with surgical clipping, Unc lippable aneurysms are at risk of recurrent bleeding similar to the na tural history of ruptured aneurysms. Aneurysm reinforcement with musli n and ethyl 2-cyanoacrylate may provide a safe and useful alternative to reduce the rebleeding rate in those aneurysms found to be unclippab le at surgical exploration. METHODS We examined a population of 19 pat ients with aneurysms treated by reinforcement with muslin and ethyl 2- cyanoacrylate, One patient was lost to follow-up, Patients had a mean follow-up of 60 months. The yearly risk of rebleeding was calculated a nd compared to the natural history of the disease. RESULTS Most of the aneurysms were located in the middle cerebral artery or the anterior communicating artery. The two main causes for reinforcement were a wid e base aneurysm or the presence of arterial branches originating from or intimately adherent to the dome. Those patients with aneurysms in w hich reinforcement was used as the primary and only treatment had a ri sk of rebleeding of 2.95% per year. The group of patients with rupture d aneurysms in which the reinforcement was used to supplement a clip h ad no rebleeding, When all the patients with ruptured aneurysms are co mbined, there is a risk of rebleeding of 1.94% per year. Unruptured an eurysms treated with reinforcement had not shown hemorrhage. No compli cations related to the use of muslin or ethyl 2-cyanoacrylate were fou nd in this study. CONCLUSION The reinforcement with muslin and ethyl 2 -cyanoacrylate provides some protection in patients with aneurysms for which direct clipping cannot be done and in those clipped cases in wh ich there is a residual neck or dome. This protection is inferior to c lipping, but reduces the risk of rebleeding during the first 6 months after the initial hemorrhage. A longer follow-up is needed to determin e if it provides better protection for late rebleeding than the natura l history of ruptured aneurysms, (C) 1997 by Elsevier Science Inc.