Acta Neurochirurgica

, Volume 149, Issue 9, pp 953–958 | Cite as

Granuloma formation and occlusion of an unruptured aneurysm after wrapping

  • R. H. Andres
  • R. Guzman
  • J. Weis
  • G. Schroth
  • A. Barth
Case Report


Excessive granulomatous foreign-body reaction is a very rare complication after wrapping of intracranial aneurysms. The pathogenetic mechanisms underlying this process are unknown. We report on a patient who developed a space-occupying granulomatous abscess after wrapping of an unruptured aneurysm of the M2/M3 bifurcation. The patient underwent revision craniotomy for abscess removal. The aneurysm was explored and found to be completely thrombosed and excluded from the circulation. Exuberant granulomatous foreign-body reaction was pathologically confirmed and Candida parapsilosis was isolated from the pus. The patient underwent an antifungal treatment regimen and recovered with no residual neurological deficits. Our findings support the assumption that a low-grade infectious process might trigger excessive inflammatory reaction after wrapping. We suggest that this process may also result in complete thrombosis of cerebral aneurysms, which is otherwise a rarely observed phenomenon.

Keywords: Cerebral aneurysm; wrapping; cotton fibre; granuloma; thrombosis. 


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  1. Amano, H, Morimoto, K, Senba, M, Wang, H, Ishida, Y, Kumatori, A, Yoshimine, H, Oishi, K, Mukaida, N, Nagatake, T 2004Essential contribution of monocyte chemoattractant protein-1/C-C chemokine ligand-2 to resolution and repair processes in acute bacterial pneumoniaJ Immunol172398409PubMedGoogle Scholar
  2. Anderson, JM 2000Multinucleated giant cellsCurr Opin Hematol74047PubMedCrossRefGoogle Scholar
  3. Bhatti, MT, Holder, CA, Newman, NJ, Hudgins, PA 2000MR characteristics of muslin-induced optic neuropathy: report of two cases and review of the literatureAm J Neuroradiol21346352PubMedGoogle Scholar
  4. Brochert, A, Reynolds, T, Baker, R 2003MRI in a case of muslin-induced granulomaNeuroradiology458284PubMedGoogle Scholar
  5. Callari, G, Marks, SM 2000Disappearance of a basilar tip aneurysm after wrappingBr J Neurosurg14146147PubMedCrossRefGoogle Scholar
  6. Carney, PG, Oatey, PE 1983Muslin wrapping of aneurysms and delayed visual failure. A report of three casesJ Clin Neuroophthalmol39196PubMedGoogle Scholar
  7. Chambi, I, Tasker, RR, Gentili, F, Lougheed, WM, Smyth, HS, Marshall, J, Young, I, Deck, J, Shrubb, J 1990Gauze-induced granuloma (“gauzoma”): an uncommon complication of gauze reinforcement of berry aneurysmsJ Neurosurg72163170PubMedGoogle Scholar
  8. Cossu, M, Pau, A, Turtas, S, Viola, C, Viale, GL 1993Subsequent bleeding from ruptured intracranial aneurysms treated by wrapping or coating: a review of the long-term results in 47 casesNeurosurgery32344346PubMedCrossRefGoogle Scholar
  9. Cudlip, SA, Kitchen, ND, McKhahn, GM, Bell, BA 1998Wrapping of solitary ruptured intracranial aneurysms, outcome at five yearsActa Neurochir (Wien)14011671170CrossRefGoogle Scholar
  10. Deshmukh, VR, Kakarla, UK, Figueiredo, EG, Zabramski, JM, Spetzler, RF 2006Long-term clinical and angiographic follow-up of unclippable wrapped intracranial aneurysmsNeurosurgery58434442PubMedGoogle Scholar
  11. Felsberg, GJ, Tien, RD, Haplea, S, Osumi, AK 1993Muslin-induced optic arachnoiditis (“gauzoma”): findings on CT and MRJ Comput Assist Tomogr17485487PubMedCrossRefGoogle Scholar
  12. Gerber, S, Dormont, D, Sahel, M, Grob, R, Foncin, JF, Marsault, C 1994Complete spontaneous thrombosis of a giant intracranial aneurysmNeuroradiology36316317PubMedCrossRefGoogle Scholar
  13. Gianetti, AV, Perpetuo, FO 1992Granuloma formation and arterial thrombosis following cotton wrapping of an intracranial aneurysm. A case reportArq Neuropsiquiatr50534538PubMedGoogle Scholar
  14. Grimes, DA, Lach, B, Bourque, PR 1998Vasculitic basilar artery thrombosis in chronic Candida albicans meningitisCan J Neurol Sci257678PubMedGoogle Scholar
  15. Haisa, T, Matsumiya, K, Yoshimasu, N, Kuribayashi, N 1990Foreign-body granuloma as a complication of wrapping and coating an intracranial aneurysm. Case reportJ Neurosurg72292294PubMedGoogle Scholar
  16. Hoh, BL, Putman, CM, Budzik, RF, Carter, BS, Ogilvy, CS 2001Combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolisationJ Neurosurg952435PubMedGoogle Scholar
  17. Huffnagle, GB, Strieter, RM, McNeil, LK, McDonald, RA, Burdick, MD, Kunkel, SL, Toews, GB 1997Macrophage inflammatory protein-1alpha (MIP-1alpha) is required for the efferent phase of pulmonary cell-mediated immunity to a Cryptococcus neoformans infectionJ Immunol159318327PubMedGoogle Scholar
  18. International Study of Unruptured Intracranial Aneurysms Investigators1998Unruptured intracranial aneurysms – risk of rupture and risks of surgical interventionN Engl J Med33917251733CrossRefGoogle Scholar
  19. Kirollos, RW, Tyagi, AK, Marks, PV, van Hille, PT 1997Muslin induced granuloma following wrapping of intracranial aneurysms: the role of infection as an additional precipitating factor. Report of two cases and review of the literatureActa Neurochir (Wien)139411415CrossRefGoogle Scholar
  20. Klotz, SA 1992Fungal adherence to the vascular compartment: a critical step in the pathogenesis of disseminated candidiasisClin Infect Dis14340347PubMedGoogle Scholar
  21. Kyriakides, TR, Foster, MJ, Keeney, GE, Tsai, A, Giachelli, CM, Clark-Lewis, I, Rollins, BJ, Bornstein, P 2004The CC chemokine ligand, CCL2/MCP1, participates in macrophage fusion and foreign body giant cell formationAm J Pathol16521572166PubMedGoogle Scholar
  22. Lawton, MT, Quinones, H, Sanai, N, Malek, JY, Dowd, CF 2003Combined microsurgical and endovascular management of complex intracranial aneurysmsNeurosurgery52263274PubMedCrossRefGoogle Scholar
  23. McFadzean, RM, Gowan, ME 1978Optochiasmal arachnoiditis after rupture of an anterior communicating artery aneurysmTrans Ophthalmol Soc UK98490493PubMedGoogle Scholar
  24. McFadzean, RM, Hadley, DM, McIlwaine, GG 1991Optochiasmal arachnoiditis following muslin wrapping of ruptured anterior communicating artery aneurysmsJ Neurosurg75393396PubMedGoogle Scholar
  25. Mount, LA, Antunes, JL 1975Results of treatment of intracranial aneurysms by wrapping and coatingJ Neurosurg42189193PubMedGoogle Scholar
  26. Pool, JL 1976Muslin gauze in intracranial vascular surgery. Technical noteJ Neurosurg44127128PubMedCrossRefGoogle Scholar
  27. Prabhu, SS, Keogh, AJ, Parekh, HC, Perera, S 1994Optochiasmal arachnoiditis induced by muslin wrapping of intracranial aneurysms. A report of two cases and a review of the literatureBr J Neurosurg8471476PubMedGoogle Scholar
  28. Sachs, E 1972The fate of muscle and cotton wrapped about intracranial carotid arteries and aneurysms. A laboratory and clinico-pathological studyActa Neurochir (Wien)26121137CrossRefGoogle Scholar
  29. Sadasivan, B, Ma, S, Dujovny, M, Ho, LK, Ausman, JI 1990Use of experimental aneurysms to evaluate wrapping materialsSurg Neurol3437PubMedCrossRefGoogle Scholar
  30. Whittle, IR, Dorsch, NW, Besser, M 1982Spontaneous thrombosis in giant intracranial aneurysmsJ Neurol Neurosurg Psychiatry4510401047PubMedGoogle Scholar
  31. Wiebers, DO, Whisnant, JP, Huston, J,III, Meissner, I, Brown, RD,Jr, Piepgras, DG, Forbes, GS, Thielen, K, Nichols, D, O’Fallon, WM, Peacock, J, Jaeger, L, Kassell, NF, Kongable-Beckman, GL, Torner, JC 2003Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatmentLancet362103110PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • R. H. Andres
    • 1
  • R. Guzman
    • 1
    • 6
  • J. Weis
    • 2
    • 3
  • G. Schroth
    • 4
  • A. Barth
    • 1
    • 5
  1. 1.Department of NeurosurgeryUniversity of BerneInselspitalSwitzerland
  2. 2.Division of Neuropathology, Department of PathologyUniversity of BerneBerneSwitzerland
  3. 3.Institute of NeuropathologyUniversity HospitalRWTH AachenGermany
  4. 4.Department of NeuroradiologyUniversity of BerneInselspitalSwitzerland
  5. 5.Department of NeurosurgeryMedical University of GrazGrazAustria
  6. 6.Department of NeurosurgeryStanford Medical SchoolStanfordUSA

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