title: Wrapping of intracranial aneurysms: Single-center series and systematic review of the literature.
abstract: BACKGROUND
  Circumferential wrapping of the aneurysm wall with a variety of materials is a well-known therapeutic approach for the repair of unclippable intracranial aneurysms (IAs). Wrapping materials can stimulate foreign-body inflammatory reactions and parent artery narrowing with resultant ischemic stroke. In this study, a single-center retrospective review of the outcome with wrapping of IAs is presented beside an analysis of existing literature.
  
  
  METHODS
  For the institutional analysis, all patients who underwent wrapping of IAs in the last five years were analyzed. For the analysis of the literature, a MEDLINE search between 1990 and the present was performed for clinical series reporting wrapping of IAs. Specifically, the risk of rebleeding, cerebrovascular complications, and the incidence of granuloma formation were evaluated.
  
  
  RESULTS
  Two hundred and ninety patients with IA were surgically treated in our department. Fifteen patients (5.2%) underwent wrapping of IA. Early parent artery narrowing occurred in one patient (6.7%) and was associated with ischemic stroke. Delayed cerebrovascular complications, including parent artery narrowing (one case), granuloma formation (one case), and fatal bleeding from an unruptured aneurysm, occurred in three patients (20%). For the review of the literature, 197 cases of wrapped aneurysms were collected. Bleeding after wrapping occurred in 16 (12%) of the patients with ruptured aneurysms. Acute ischemic complications were reported in 7 cases (3.5%) and granuloma formation was observed in 3 patients (1.5%).
  
  
  CONCLUSIONS
  These data suggest that the microsurgical wrapping of IAs present a risk of ischemic complications and granuloma formation. Additionally, the rebleeding rate of ruptured aneurysms remains high, although still lower than the natural history of untreated ruptured aneurysms.
authors: a Department of Neurosurgery Azienda Ospedaliero Universitaria Pisana (AOUP) , Pisa , Italy.
authors: Paolo
authors: P
authors: Perrini
authors: a Department of Neurosurgery Azienda Ospedaliero Universitaria Pisana (AOUP) , Pisa , Italy.
authors: Nicola
authors: N
authors: Montemurro
authors: a Department of Neurosurgery Azienda Ospedaliero Universitaria Pisana (AOUP) , Pisa , Italy.
authors: Michele
authors: M
authors: Caniglia
authors: b Department of Neuroradiology , Azienda Ospedaliero Universitaria Pisana (AOUP) , Pisa , Italy.
authors: Guido
authors: G
authors: Lazzarotti
authors: a Department of Neurosurgery Azienda Ospedaliero Universitaria Pisana (AOUP) , Pisa , Italy.
authors: Nicola
authors: N
authors: Benedetto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000601:surgery; D001458:Bandages / Q000009:adverse effects; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000209:etiology; D005260:Female; D023261:Glasgow Outcome Scale; D015745:Granuloma, Foreign-Body / Q000209:etiology / Q000628:therapy; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology
keywords: cerebrovascular complications; intracranial aneurysm; muslinoma; wrapping