Ebs_July2013_wraps

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  • Ebs_July2013_wraps

    1. 1. EBS presentation 1 Risk of rupture of previously “wrapped” intracranial aneurysms Macquarie Neurosurgery Evidence Based Surgery presentation 11th July, 2013 Peter Wilson
    2. 2. EBS presentation 2 Clinical case • 60 year old lady • Smoker • Wrapping of unruptured complex calcified MCA aneurysm 6 years ago • MCA infarct post-op – Spastic hemiplegia • Previously recommended 3 monthly CTAs
    3. 3. EBS presentation 3 Searchable question (PICO format) • P = patients with previously wrapped intracranial aneurysms • I = wrap • C = clipping • O = haemorrhage / rupture rate
    4. 4. EBS presentation 4 Search strategy • Intracranial aneurysm • Wrap (or similar) – Muslin – Gauze – Bandage – Mesh
    5. 5. EBS presentation 5 Search results
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    25. 25. EBS presentation 25 Summary of papers • Few large series • Risk of rupture greatest initially • ?similar to natural history in long term • Risk of local complications
    26. 26. EBS presentation 26 Conclusions • Wrapping is not an ideal treatment strategy • “Unclippable” defined by treating surgeon – ?small clips for aneurysms <3 mm – ?bypass alternatives

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