[Teflon wrapping in cerebral aneurysm surgery. A technical note].

Abstract

Wrapping is a well-known alternative technique when clipping the aneurysm is by no means possible or when it seems necessary to complete an imperfect clip. In 22 operated cases of intracranial aneurysm, we recently experienced pledgets of Teflon arranged and then fixed by drops of fibrin sealant. We used this technique in the following operative circumstances: to reinforce the ectatic base of the clipped aneurysm (11 cases); to wrap a pre-aneurysmal ectasia distant from the ruptured aneurysm (5 cases); to minimize the compression due to the clip to an adjacent cranial nerve or artery (6 cases). So far no complication was noted in relation to this technique. We then propose this technique of wrapping or interposing Teflon as an alternative to the other well-known techniques using autogenous tissue, gelatin sponge, cotton or other synthetic coatings or glue. Up to now, no known material received a worldwide approval for its complete innocuity and/or efficiency. Nowadays, in neurosurgical microvascular decompression and in cardiovascular surgery Teflon is widely and satisfactorily used. Its biologic tolerance is known to be good. This may apply in this new indication, and we would like recommend its practical use. However, for reliability and safety, there is an obvious need for a long-term clinical follow-up and an experimental controlled study as well.