Abstract
During the four years between 1992 and 1995, we treated 17 cerebral aneurysms with severe atherosclerosis around them. Nine of the cases were operated without any measure for severe atherosclerosis (non-reinforcement group). But recently, 8 cases were clipped after reinforcement for the aneurysmal neck using Surgicel® and Biobond® (reinforcement group).
In the non-reinforcement group, 3 cases were clipped with a temporary clip, 1 was treated with multiple clipping, and 5 were treated with a single clip. Of the 5 single clippings, 2 had residual necks. The other 2 cases were treated with dome clipping and neck coating.
In the reinforcement group, 1 case was treated with a temporary clip, 2 were treated with multiple clipping, and 5 were treated with a single clip. There were no residual neck and coating methods.
In the non-reinforcement group 4 cases experienced intraoperative ruptures, 1 slipping out of the clipping, and 1 injury of the parent artery. In the three intraoperative rupture cases, the wall between aneurysmal neck and atherosclerotic lesion was split by the clip. However, there was only 1 case of perforating artery injury in the reinforcement group. Histopathological findings about the aneurysmal neck with atherosclerosis around them show a frail portion between the aneurysmal wall and atherosclerotic lesion.
In conclusion, the reinforcement technique for aneurysmal neck with severe atherosclerosis might be useful to prevent the neck splitting and slipping out of clips.
