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Wrap-Clipping is the authors' preferred technique. A wrapped surface may help the clip to remain stationary and prevent tearing at the weakest spot. If the lesion is buried in the cortical surface, subpial dissection must be facilitated.Īfter enveloping the entire aneurysm segment, the portion of the aneurysm body that appears acceptable to approximate is clip-ligated as much as possible over the wrapped material (Wrap-Clip). In cases of subarachnoid hemorrhage, care must be taken not to violate the clot scab around the rupture point during circumferential dissection. To encase the aneurysmal segment of the parent artery circumferentially with the cotton strip, ample room to allow free manipulation with micro forceps and angled micro dissectors was essential.
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On occasion, tailoring strips into a Y-shape was useful to accommodate side branches and perforators. A thin layer peeled away from a microsurgical cotton pad (Bemsheet®, Kawamoto, Osaka, Japan) was prepared to the proper length and width. In all cases, cellulose cotton fabric was used as the wrapping agent. Therefore, the present study attempted to clarify the detailed surgical techniques thereof and investigate the clinical and angiographic follow-up results for 24 consecutive patients who underwent wrap-clipping microsurgery using cellulose cotton fabric. Furthermore, the fate of a wrapped aneurysm requires further long term evaluation of its efficacy and stability. Nonetheless, because of case rarity, disregard for incomplete extirpation, and extemporaneous manner of technique, previous reports are not readily available in regard with currently used techniques and the delicate nuances thereof.
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Among them, wrapping may be the simplest way for surgeons to prevent further bleeding and simultaneously save normal arterial flow. Various surgical methods for unclippable aneurysms include parent artery sacrification, trapping with or without arterial bypass, aneurysmectomy following direct suture, and wrapping with reinforcements. Friable blister-like aneurysms and fusiform aneurysms lacking an identifiable neck are representative of such challenging cases, for which many surgeons occasionally employ substitutional surgical techniques rather than direct neck clippings. Although recent advances in microsurgical and endovascular techniques have allowed many challenging cerebral aneurysms to be successfully treated, a small subset are still not amenable to any definitive treatment.