title: Muslin-induced intracranial vasculopathic stenosis: a report of two cases.
abstract: Muslin wrapping is a commonly utilized alternative technique in the treatment of aneurysms that are not amenable to direct clipping. In this case report, we describe two patients from different institutions who both required aneurysm wrapping with gauze/muslin for aneurysm reinforcement. Both patients developed an inflammatory foreign body response to muslin visible on MRI that resulted in a vasculitic stenosis. The onset of TIAs was at 6 months and 1 month postoperatively, respectively. The stenoses rapidly progressed to near occlusion despite antiplatelet therapy, and in one case, an aggressive corticosteroid regimen. One patient eventually developed leptomeningeal collateral flow that allowed tolerance of the stenosis, while the other patient required microsurgical bypass. These cases reports are the first to our knowledge that describe the adverse effects of muslin wrapping without adhesive reinforcement, as well as one of few reports to include follow-up angiographic imaging.
authors.affiliation: Department of Radiology, Georgetown University Hospital, Washington, DC 20005-2113,USA. dwl103@gunet.georgetown.edu
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lee
authors.forename: Mandy J
authors.initials: MJ
authors.lastname: Binning
authors.forename: Victoria K
authors.initials: VK
authors.lastname: Shanmugam
authors.forename: Richard H
authors.initials: RH
authors.lastname: Schmidt
authors.forename: William T
authors.initials: WT
authors.lastname: Couldwell
authors.forename: Maximilian
authors.initials: M
authors.lastname: Meyer
authors.forename: Thomas
authors.initials: T
authors.lastname: Cupps
authors.forename: Andrea
authors.initials: A
authors.lastname: Douglas
authors.forename: Kevin
authors.initials: K
authors.lastname: McGrail
mesh_terms: D000328:Adult; D017130:Angioplasty; D001458:Bandages / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000378:metabolism; D016893:Carotid Stenosis / Q000209:etiology; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000209:etiology*; D002536:Cerebral Arteries / Q000601:surgery / Q000637:transplantation; D003251:Constriction, Pathologic; D003399:Craniotomy; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000209:etiology; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D014014:Tissue Adhesives / Q000009:adverse effects
chemical_list: D014014:Tissue Adhesives; D002097:C-Reactive Protein