• Antonino Germanò, Stefano Priola, Filippo Flavio Angileri, Alfredo Conti, Domenico La Torre, Salvatore Cardali, Giovanni Raffa, Lucia Merlo, Francesca Granata, Marcello Longo, and Francesco Tomasello.
• Neurosurgical Clinic, Department of Neurosciences, Psychiatry and Anaesthesiology, University of Messina Medical School, A.O.U. Policlinico G. Martino, Via Consolare Valeria, 1, 98125, Messina, Italy.
• Neurosurg Rev. 2013 Jan 1; 36 (1): 123-31; discussion 132.

AbstractThe purpose of this study is to describe our series of nine unclippable and uncoilable ruptured aneurysms in eight patients treated by microsurgical wrapping with autologous muscle. Records were retrospectively reviewed for rebleeding rate, morbidity and mortality, changes in size or the aneurysm's configurations, and inflammatory reaction. We conducted a Medline search in the post-microsurgical era, excluding patients in whom wrapping was part of the aneurysm treatment in combination with clipping or coiling. The surgically related morbidity was 12.5%. Global mortality rate was 25% due to vasospasm (one case) and rebleeding (one case). Six patients are still alive. Rebleeding rate was 14.3% within 6 months; then, it was zero. Glasgow outcome scale (GOS) score at discharge was 1 and 4 in one patient, respectively, and 5 in the remaining six. Mean clinical follow-up was 126 months. GOS at last follow-up was 4 and 5 in 50% of patients, respectively. Mean mRS score was 0.8 at 2 months, and 2.4 at 12 months. Follow-up MR demonstrated persistence of the aneurysm's sac, without changes in size and configuration. Patients did not describe or exhibit symptoms attributable to complications inherent to the use of muscle. Microsurgical muscle-wrapping of ruptured intracranial aneurysm is safe, is associated with a low rate of acute and delayed postoperative complications and rebleeding, and could be a valid alternative for unclippable and non-amenable to endovascular procedure ruptured aneurysms.

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