Ebs_July2013_wraps
-
Upload
mqlibrary -
Category
Health & Medicine
-
view
434 -
download
0
Transcript of Ebs_July2013_wraps
EBS presentation 1
Risk of rupture of previously “wrapped” intracranial aneurysms
Macquarie Neurosurgery
Evidence Based Surgery presentation
11th July, 2013
Peter Wilson
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
EBS presentation 3
Searchable question (PICO format)
• P = patients with previously wrapped intracranial aneurysms
• I = wrap• C = clipping• O = haemorrhage / rupture rate
EBS presentation 4
Search strategy
• Intracranial aneurysm• Wrap (or similar)
– Muslin– Gauze– Bandage– Mesh
EBS presentation 5
Search results
EBS presentation 6
EBS presentation 7
EBS presentation 8
EBS presentation 9
EBS presentation 10
EBS presentation 11
EBS presentation 12
EBS presentation 13
EBS presentation 14
EBS presentation 15
EBS presentation 16
EBS presentation 17
EBS presentation 18
EBS presentation 19
EBS presentation 20
EBS presentation 21
EBS presentation 22
EBS presentation 23
EBS presentation 24
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
EBS presentation 26
Conclusions
• Wrapping is not an ideal treatment strategy• “Unclippable” defined by treating surgeon
– ?small clips for aneurysms <3 mm– ?bypass alternatives