Falxuplication, a Novel Method for Wrap-Clipping a Fusiform Aneurysm: Technical Note

World Neurosurg. 2018 Jan:109:40-46. doi: 10.1016/j.wneu.2017.09.059. Epub 2017 Sep 20.


Background: Various techniques have been used for wrap-clipping a ruptured, fusiform intracranial aneurysm; however, there is no available literature on use of the falx cerebri for wrap-clipping. We present a review of the literature, with an illustrative case, of a ruptured fusiform pericallosal artery aneurysm firmly attached to the lower edge of the falx cerebri and not amenable to endovascular intervention.

Methods: Although the firm attachment between the inferior falx and the fusiform aneurysm was maintained, a section of the lower thinner part of the falx cerebri firmly attached to the aneurysm was dissected and wrapped around the fusiform aneurysm, and then stabilized with a fenestrated clip. We chose a segment slightly longer than the length of the fusiform aneurysm to avoid pre- and post-wrap-clipping stenosis.

Results: Postprocedure, except for a small area of numbness on the left distal anterolateral left leg, the patient was neurologically intact and remained neurologically intact at a 12-month follow-up.

Conclusions: An inferior thin segment of the falx cerebri can be used for wrap-clipping of ruptured fusiform anterior cerebral artery aneurysms. Furthermore, the inferior falx can be wrapped around the attached fusiform anterior cerebral artery aneurysm without compromising flow, offering a safe solution in these unusually complex cases.

Keywords: Falx cerebri; Falxuplication; Fusiform aneurysm; Wrap-clipping.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Angiography, Digital Subtraction
  • Cerebral Angiography
  • Computed Tomography Angiography
  • Female
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery*
  • Neurosurgical Procedures / methods*
  • Spinal Cord / surgery*
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / etiology
  • Subarachnoid Hemorrhage / surgery*
  • Surgical Instruments
  • Tomography, X-Ray Computed