Wrapping of solitary ruptured intracranial aneurysms, outcome at five years

Previous follow up studies of patients who have had ruptured intracranial a neurysms treated by a wrapping technique have largely been in the pre-micro surgical era. Our objective was to ascertain whether wrapping aneurysms wit h the aid of the operating microscope provides protection against rebleedin g in the short and long term. The study involved retrospective analysis of patients with ruptured aneurysms treated by wrapping over a six-year period . Twenty-nine patients were identified with wrapped aneurysms, of these 15 had wrapping of a solitary ruptured aneurysm, the remainder were excluded b ecause of clip/wrap combination, multiple aneurysms, and unruptured aneurys ms. Of the 15 patients who had a solitary ruptured aneurysm wrapped, none h ad rebled at one year follow up. One patient died of a myocardial infarctio n at 4 years, the remaining 14 patients had no episodes of rebleeding with all patients achieving Glasgow outcome scores of four or five at 5 years fo llow-up. Although surgical clipping of intracranial aneurysms is the defini tive method of treatment, our findings suggest that wrapping of ruptured in tracranial aneurysms with the aid of the operating microscope confers good protection against both early and late rebleeding in those cases considered 'unclippable'.