title: Aneurysm reinforcement in the anterior circulation.
abstract: BACKGROUND
  Aneurysms are primarily treated with surgical clipping. Unclippable aneurysms are at risk of recurrent bleeding similar to the natural history of ruptured aneurysms. Aneurysm reinforcement with muslin and ethyl 2-cyanoacrylate may provide a safe and useful alternative to reduce the rebleeding rate in those aneurysms found to be unclippable at surgical exploration.
  
  
  METHODS
  We examined a population of 19 patients 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 and 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 wide base aneurysm or the presence of arterial branches originating from or intimately adherent to the dome. Those patients with aneurysms in which reinforcement was used as the primary and only treatment had a risk of rebleeding of 2.95% per year. The group of patients with ruptured aneurysms in which the reinforcement was used to supplement a clip had no rebleeding. When all the patients with ruptured aneurysms are combined, there is a risk of rebleeding of 1.94% per year. Unruptured aneurysms treated with reinforcement had not shown hemorrhage. No complications related to the use of muslin or ethyl 2-cyanoacrylate were found in this study.
  
  
  CONCLUSIONS
  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 which there is a residual neck or dome. This protection is inferior to clipping, but reduces the risk of rebleeding during the first 6 months after the initial hemorrhage. A longer follow-up is needed to determine if it provides better protection for late rebleeding than the natural history of ruptured aneurysms.
authors.affiliation: Section of Neurosurgery, University of Puerto Rico, San Juan 00936, USA.
authors.forename: O
authors.initials: O
authors.lastname: De Jesús
authors.forename: V
authors.initials: V
authors.lastname: Hernández
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012189:Retrospective Studies