Outcome of Ruptured Intracranial Aneurysms Treated by Coating

ABSTRACT

In rare occasions in which aneurysmal neck clipping is nearly impossible, coating is employed. During the period from 1985 to 1992, 312 patients with aneurysm underwent surgery;aneurysmal neck clipping were performed in 284 cases while coating only in 28. The reasons that coating was required were;wide and broad neck in 13, perforators arising from the neck in 4, neck tearing during dissection in 3, very friable neck in 2, severe adhesion with surrounding structures in 3, and small aneurysm without enough room for clipping in 3. In twenty-three cases, cotton wisp and bioglue were used as coating materials. In another five cases, the aneurysmal wall was reinforced using Surgical or Gelfoam. Patients were followed for 24 months on average of all the patients. Four had last contack. Six died(4 due to rebleeding and 2 due to pneumonia). Fourteen were good and 4 were moderately disabled. There were no rebleeding incidences during first three months' follow-up after coating. We thus concluded that coating an aneurysm offers some protection from rebleeding, particularly when the rebleeding risk period is over.