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Granuloma formation and occlusion of an unruptured aneurysm after wrapping

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Summary

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.

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References

  • H Amano K Morimoto M Senba H Wang Y Ishida A Kumatori H Yoshimine K Oishi N Mukaida T Nagatake (2004) ArticleTitleEssential contribution of monocyte chemoattractant protein-1/C-C chemokine ligand-2 to resolution and repair processes in acute bacterial pneumonia J Immunol 172 398–409 Occurrence Handle14688348 Occurrence Handle1:CAS:528:DC%2BD3sXpvFehurk%3D

    PubMed  CAS  Google Scholar 

  • JM Anderson (2000) ArticleTitleMultinucleated giant cells Curr Opin Hematol 7 40–47 Occurrence Handle10608503 Occurrence Handle10.1097/00062752-200001000-00008 Occurrence Handle1:STN:280:DC%2BD3c%2FnsVajsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • MT Bhatti CA Holder NJ Newman PA Hudgins (2000) ArticleTitleMR characteristics of muslin-induced optic neuropathy: report of two cases and review of the literature Am J Neuroradiol 21 346–352 Occurrence Handle10696022 Occurrence Handle1:STN:280:DC%2BD3c7lvVGluw%3D%3D

    PubMed  CAS  Google Scholar 

  • A Brochert T Reynolds R Baker (2003) ArticleTitleMRI in a case of muslin-induced granuloma Neuroradiology 45 82–84 Occurrence Handle12592488 Occurrence Handle1:STN:280:DC%2BD3s%2FotVGrsQ%3D%3D

    PubMed  CAS  Google Scholar 

  • G Callari SM Marks (2000) ArticleTitleDisappearance of a basilar tip aneurysm after wrapping Br J Neurosurg 14 146–147 Occurrence Handle10889891 Occurrence Handle10.1080/02688690050004615 Occurrence Handle1:STN:280:DC%2BD3czkvVeltQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • PG Carney PE Oatey (1983) ArticleTitleMuslin wrapping of aneurysms and delayed visual failure. A report of three cases J Clin Neuroophthalmol 3 91–96 Occurrence Handle6224820 Occurrence Handle1:STN:280:DyaL3s3ptFKjug%3D%3D

    PubMed  CAS  Google Scholar 

  • I Chambi RR Tasker F Gentili WM Lougheed HS Smyth J Marshall I Young J Deck J Shrubb (1990) ArticleTitleGauze-induced granuloma (“gauzoma”): an uncommon complication of gauze reinforcement of berry aneurysms J Neurosurg 72 163–170 Occurrence Handle2404088 Occurrence Handle1:STN:280:DyaK3c7htFyhtg%3D%3D

    PubMed  CAS  Google Scholar 

  • M Cossu A Pau S Turtas C Viola GL Viale (1993) ArticleTitleSubsequent bleeding from ruptured intracranial aneurysms treated by wrapping or coating: a review of the long-term results in 47 cases Neurosurgery 32 344–346 Occurrence Handle8455758 Occurrence Handle10.1097/00006123-199303000-00002 Occurrence Handle1:STN:280:DyaK3s3gsFWlsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • SA Cudlip ND Kitchen GM McKhahn BA Bell (1998) ArticleTitleWrapping of solitary ruptured intracranial aneurysms, outcome at five years Acta Neurochir (Wien) 140 1167–1170 Occurrence Handle10.1007/s007010050232 Occurrence Handle1:STN:280:DyaK1M%2Fos1yrtQ%3D%3D

    Article  CAS  Google Scholar 

  • VR Deshmukh UK Kakarla EG Figueiredo JM Zabramski RF Spetzler (2006) ArticleTitleLong-term clinical and angiographic follow-up of unclippable wrapped intracranial aneurysms Neurosurgery 58 434–442 Occurrence Handle16528182

    PubMed  Google Scholar 

  • GJ Felsberg RD Tien S Haplea AK Osumi (1993) ArticleTitleMuslin-induced optic arachnoiditis (“gauzoma”): findings on CT and MR J Comput Assist Tomogr 17 485–487 Occurrence Handle8491918 Occurrence Handle10.1097/00004728-199305000-00030 Occurrence Handle1:STN:280:DyaK3s3mtVWrsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • S Gerber D Dormont M Sahel R Grob JF Foncin C Marsault (1994) ArticleTitleComplete spontaneous thrombosis of a giant intracranial aneurysm Neuroradiology 36 316–317 Occurrence Handle8065580 Occurrence Handle10.1007/BF00593270 Occurrence Handle1:STN:280:DyaK2czksVCjtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • AV Gianetti FO Perpetuo (1992) ArticleTitleGranuloma formation and arterial thrombosis following cotton wrapping of an intracranial aneurysm. A case report Arq Neuropsiquiatr 50 534–538 Occurrence Handle1309163 Occurrence Handle1:STN:280:DyaK3szptlCltA%3D%3D

    PubMed  CAS  Google Scholar 

  • DA Grimes B Lach PR Bourque (1998) ArticleTitleVasculitic basilar artery thrombosis in chronic Candida albicans meningitis Can J Neurol Sci 25 76–78 Occurrence Handle9532286 Occurrence Handle1:STN:280:DyaK1c7ptlCmtg%3D%3D

    PubMed  CAS  Google Scholar 

  • T Haisa K Matsumiya N Yoshimasu N Kuribayashi (1990) ArticleTitleForeign-body granuloma as a complication of wrapping and coating an intracranial aneurysm. Case report J Neurosurg 72 292–294 Occurrence Handle2136243 Occurrence Handle1:STN:280:DyaK3c7htFynsQ%3D%3D

    PubMed  CAS  Google Scholar 

  • BL Hoh CM Putman RF Budzik BS Carter CS Ogilvy (2001) ArticleTitleCombined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolisation J Neurosurg 95 24–35 Occurrence Handle11453395 Occurrence Handle1:STN:280:DC%2BD3Mvgt1Ckuw%3D%3D

    PubMed  CAS  Google Scholar 

  • GB Huffnagle RM Strieter LK McNeil RA McDonald MD Burdick SL Kunkel GB Toews (1997) ArticleTitleMacrophage inflammatory protein-1alpha (MIP-1alpha) is required for the efferent phase of pulmonary cell-mediated immunity to a Cryptococcus neoformans infection J Immunol 159 318–327 Occurrence Handle9200469 Occurrence Handle1:CAS:528:DyaK2sXktFCnurY%3D

    PubMed  CAS  Google Scholar 

  • InstitutionalAuthorNameInternational Study of Unruptured Intracranial Aneurysms Investigators (1998) ArticleTitleUnruptured intracranial aneurysms – risk of rupture and risks of surgical intervention N Engl J Med 339 1725–1733 Occurrence Handle10.1056/NEJM199812103392401

    Article  Google Scholar 

  • RW Kirollos AK Tyagi PV Marks PT van Hille (1997) ArticleTitleMuslin induced granuloma following wrapping of intracranial aneurysms: the role of infection as an additional precipitating factor. Report of two cases and review of the literature Acta Neurochir (Wien) 139 411–415 Occurrence Handle10.1007/BF01808876 Occurrence Handle1:STN:280:DyaK2szkvVSnsA%3D%3D

    Article  CAS  Google Scholar 

  • SA Klotz (1992) ArticleTitleFungal adherence to the vascular compartment: a critical step in the pathogenesis of disseminated candidiasis Clin Infect Dis 14 340–347 Occurrence Handle1571448 Occurrence Handle1:STN:280:DyaK383jvFGqsg%3D%3D

    PubMed  CAS  Google Scholar 

  • TR Kyriakides MJ Foster GE Keeney A Tsai CM Giachelli I Clark-Lewis BJ Rollins P Bornstein (2004) ArticleTitleThe CC chemokine ligand, CCL2/MCP1, participates in macrophage fusion and foreign body giant cell formation Am J Pathol 165 2157–2166 Occurrence Handle15579457 Occurrence Handle1:CAS:528:DC%2BD2MXhs1KmsA%3D%3D

    PubMed  CAS  Google Scholar 

  • MT Lawton H Quinones N Sanai JY Malek CF Dowd (2003) ArticleTitleCombined microsurgical and endovascular management of complex intracranial aneurysms Neurosurgery 52 263–274 Occurrence Handle12535354 Occurrence Handle10.1227/01.NEU.0000043642.46308.D1

    Article  PubMed  Google Scholar 

  • RM McFadzean ME Gowan (1978) ArticleTitleOptochiasmal arachnoiditis after rupture of an anterior communicating artery aneurysm Trans Ophthalmol Soc UK 98 490–493 Occurrence Handle291211 Occurrence Handle1:STN:280:DyaL3c%2FjslemtA%3D%3D

    PubMed  CAS  Google Scholar 

  • RM McFadzean DM Hadley GG McIlwaine (1991) ArticleTitleOptochiasmal arachnoiditis following muslin wrapping of ruptured anterior communicating artery aneurysms J Neurosurg 75 393–396 Occurrence Handle1869940 Occurrence Handle1:STN:280:DyaK3Mzjt1Klsg%3D%3D

    PubMed  CAS  Google Scholar 

  • LA Mount JL Antunes (1975) ArticleTitleResults of treatment of intracranial aneurysms by wrapping and coating J Neurosurg 42 189–193 Occurrence Handle1113153 Occurrence Handle1:STN:280:DyaE2M%2Fps1ylsA%3D%3D

    PubMed  CAS  Google Scholar 

  • JL Pool (1976) ArticleTitleMuslin gauze in intracranial vascular surgery. Technical note J Neurosurg 44 127–128 Occurrence Handle1244428 Occurrence Handle1:STN:280:DyaE28%2FntFSgug%3D%3D Occurrence Handle10.3171/jns.1976.44.1.0127

    Article  PubMed  CAS  Google Scholar 

  • SS Prabhu AJ Keogh HC Parekh S Perera (1994) ArticleTitleOptochiasmal arachnoiditis induced by muslin wrapping of intracranial aneurysms. A report of two cases and a review of the literature Br J Neurosurg 8 471–476 Occurrence Handle7811414 Occurrence Handle1:STN:280:DyaK2M7htVCksw%3D%3D

    PubMed  CAS  Google Scholar 

  • E Sachs (1972) ArticleTitleThe fate of muscle and cotton wrapped about intracranial carotid arteries and aneurysms. A laboratory and clinico-pathological study Acta Neurochir (Wien) 26 121–137 Occurrence Handle10.1007/BF01406549

    Article  Google Scholar 

  • B Sadasivan S Ma M Dujovny LK Ho JI Ausman (1990) ArticleTitleUse of experimental aneurysms to evaluate wrapping materials Surg Neurol 34 3–7 Occurrence Handle2360161 Occurrence Handle10.1016/0090-3019(90)90165-L Occurrence Handle1:STN:280:DyaK3c3ps1alsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • IR Whittle NW Dorsch M Besser (1982) ArticleTitleSpontaneous thrombosis in giant intracranial aneurysms J Neurol Neurosurg Psychiatry 45 1040–1047 Occurrence Handle7175528 Occurrence Handle1:STN:280:DyaL3s%2FosV2isg%3D%3D

    PubMed  CAS  Google Scholar 

  • DO Wiebers JP Whisnant J Huston SuffixIII I Meissner RD Brown SuffixJr DG Piepgras GS Forbes K Thielen D Nichols WM O’Fallon J Peacock L Jaeger NF Kassell GL Kongable-Beckman JC Torner (2003) ArticleTitleUnruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment Lancet 362 103–110 Occurrence Handle12867109 Occurrence Handle10.1016/S0140-6736(03)13860-3

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, University of Berne, Inselspital, Berne, Switzerland

    R. H. Andres, R. Guzman & A. Barth

  2. Division of Neuropathology, Department of Pathology, University of Berne, Berne, Switzerland

    J. Weis

  3. Institute of Neuropathology, University Hospital, RWTH Aachen, Germany

    J. Weis

  4. Department of Neuroradiology, University of Berne, Inselspital, Berne, Switzerland

    G. Schroth

  5. Department of Neurosurgery, Medical University of Graz, Graz, Austria

    A. Barth

  6. Department of Neurosurgery, Stanford Medical School, Stanford, USA

    R. Guzman

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  1. R. H. Andres
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  2. R. Guzman
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  3. J. Weis
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  4. G. Schroth
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  5. A. Barth
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Andres, R., Guzman, R., Weis, J. et al. Granuloma formation and occlusion of an unruptured aneurysm after wrapping. Acta Neurochir (Wien) 149, 953–958 (2007). https://doi.org/10.1007/s00701-007-1260-8

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  • DOI: https://doi.org/10.1007/s00701-007-1260-8

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