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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Efficacy of clip-wrapping in treatment of complex pediatric aneurysms
Christian Bowers1, Jay Riva-Cambrin, William T Couldwell
1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132, USA.
Insights
Clip wrapping is an effective treatment for complex pediatric aneurysms that are difficult to manage with standard surgical methods. This technique shows promising results in improving patient outcomes and vessel patency.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Surgery
Background:
- Pediatric aneurysms (PAs) differ significantly from adult aneurysms in location, type, and risk factors.
- Conventional treatments for PAs are often challenging, particularly for complex or unclippable cases.
- Clip wrapping, a technique commonly used in adults, has been rarely reported for pediatric patients.
Observation:
- A retrospective review identified five pediatric patients treated with clip wrapping over a five-year period.
- Patient presentations included traumatic pseudoaneurysms, mycotic pseudoaneurysm rupture, and complex dissecting aneurysms.
- The study evaluated clinical presentation, surgical management, and both clinical and radiological outcomes.
Findings:
- Four out of five patients achieved good clinical outcomes (Glasgow Outcome Scale score of 5) at long-term follow-up.
- Postoperative imaging confirmed vessel patency and no recurrent hemorrhages or aneurysm enlargement in most cases.
- One patient experienced delayed progressive arterial occlusion with a minor, fully recovered ischemic event.
Implications:
- Clip wrapping represents an effective, yet underutilized, strategy for treating complex pediatric aneurysms.
- This technique offers a viable solution for pediatric aneurysms deemed unclippable by conventional surgical approaches.
- Further research into clip wrapping for pediatric cerebrovascular conditions may expand treatment options.
Purpose:
Pediatric aneurysms (PAs) are distinct from their adult counterparts with respect to typical location, aneurysm type, and known predisposing risk factors. Many strategies have been employed to treat PAs, but although it has been used frequently in adults, clip wrapping in pediatric patients has only been reported once. We present a series of pediatric patients that underwent clip wrapping and discuss this strategy as an effective means of treating unclippable PAs.
Methods:
Pediatric patients with clip-wrapped aneurysms over a 5-year period were retrospectively identified. Clinical presentation, surgical management, and clinical and radiological outcome of the patients were evaluated.
Results:
Five pediatric patients with aneurysms were treated with clip wrapping during the specified period. Three had traumatic pseudoaneurysms, with two subarachnoid hemorrhages from aneurysm rupture. One patient presented with mycotic pseudoaneurysm rupture causing a large intraparenchymal and subarachnoid hemorrhage. Another patient had a dissecting complex saccular lenticulostriate aneurysm with four perforating vessels arising from the dome. Four patients had good clinical results, with Glasgow Outcome Scale (GOS) scores of 5 after at least 1-year follow-up (mean 24.2); one patient had a GOS score of 5 at discharge, but no additional follow-up. Postoperative neuroimaging demonstrated vessel patency after clip wrapping with no recurrent hemorrhages or increase in aneurysm size; however, one had progressive occlusion of the artery in a delayed fashion and had a small clinical ischemic event from which she fully recovered.
Conclusions:
Clip wrapping appears to be an effective underutilized technique for treatment of pediatric complex aneurysms that cannot be treated with conventional methods.
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