Elsevier

World Neurosurgery

Volume 109, January 2018, Pages 271-274
World Neurosurgery

Case Report
Suturing Treatment for Blood Blister–Like Aneurysm in Supraclinoid Segment of Internal Carotid Artery

https://doi.org/10.1016/j.wneu.2017.09.203Get rights and content

Background

Blood blister–like aneurysms (BBAs) are rare but dangerous and challenging to treat. Recurrence and rebleeding are often reported, and many neurosurgeons and interventional radiologists are discouraged by such poor outcomes. Currently, there is no standard method to treat this type of aneurysm.

Case Description

We describe 5 cases of ruptured BBAs in the supraclinoid segment of the internal carotid artery, which were treated successfully using a suturing technique. No patient experienced recurrence or rebleeding, and all patients had a good prognosis.

Conclusions

We conclude that this suturing technique is an optional safe and reliable method to treat BBAs.

Introduction

A blood blister–like aneurysm (BBA) refers to a rare but extremely dangerous type of aneurysm, which represents 0.5% of all intracranial aneurysms.1 While most intracranial aneurysms are found in the vascular branches, BBAs are mostly observed in nonbranching segments of arteries, mainly in the dorsal wall of the internal carotid artery (ICA). Because of its lack of normal walls and identifiable necks, BBAs present a difficult therapeutic challenge and the optimal treatment still remains uncertain. Various treatments have been applied including direct clipping, suturing, wrapping, trapping with or without bypass, coiling, stenting, flow-diverting stents, and multiple stents.2, 3, 4 However, some authors have reported poor outcomes of surgery or endovascular treatment for BBAs. In their reports, some patients suffered from postoperative recurrence, rebleeding, or brain infarction.5, 6 In the present report, we describe 5 cases of BBAs that were treated successfully by suturing the ICA and discuss the optional treatments for this type of aneurysm.

Section snippets

Case Material

This study features 5 patients including 4 females and 1 male, aged 38 to 63 years (mean age, 45.2 years). All patients presented with subarachnoid hemorrhage (SAH), while 1 case had concurrent temporal lobe hematoma. Hunt-Hess classifications were grade II in 3 patients, grade III in 1 patient, and grade IV in 1 patient. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) revealed BBA in the dorsal wall of the supraclinoid segment of the ICA (Table 1).

Before

Results

Four patients recovered well and were discharged without any neurologic deficit. The patient with Hunt-Hess classification grade IV woke up from a coma on postoperative day 5 and underwent rehabilitation training for 1 month. She fully recovered and was discharged. Currently, she is able to live normally, except for experiencing occasional epileptic seizures. Three months later, patients were evaluated using the modified Rankin Scale (see Table 1).

All patients' follow-up periods ranged from 6

Discussion

BBAs are mainly located in the supraclinoid segment of the ICA, which are also called superior or dorsal wall aneurysms of the ICA. Currently, there is no standard efficient treatment for BBAs. A search of PubMed using the keyword “blood blister–like aneurysm” revealed several interventional methods, including coil embolization plus multiple stent or flow-diverting stent implantation, as well as microsurgical methods including direct clipping, suturing, and extracranial-intracranial bypass.

Conclusion

Direct suturing technique may be a safe and reliable method to treat BBAs.

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Conflict of interest statement: There are no conflicts of interest to declare.

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