Aneurysm—TechniqueArterial suturing followed by clip reinforcement with circumferential wrapping for blister-like aneurysms of the internal carotid artery
Introduction
Aneurysms arising from the dorsal wall of the ICA, known as blister-like aneurysms, have been reported to have extremely thin, fragile walls with a marked tendency to rupture intraoperatively [1], [2], [5], [7], [10], [11], [14], [16]. These lesions rupture easily with surgical manipulation, resulting in an arterial wall defect in the ICA. In such situations [1], [5], [7], it is very difficult to reconstruct the ICA while preserving patency of the parent artery. Recently, we had an intraoperative arterial tear at the base of a blister-like aneurysm. We report two cases of a useful technique where direct suture of the arterial tear on the blister-like aneurysm, followed by a clip reinforcement technique and circumferential wrapping with silastic sheet, was successfully used.
Section snippets
History and examination
This 30-year-old man had a sudden onset of headache and vomiting. He was initially transported to a local hospital before he was referred to our hospital for further management of SAH. On admission, his neurological symptoms were unremarkable except for drowsiness. His condition was graded as Hunt and Hess grade III. Computerized tomography showed a dense and diffuse SAH at the basal cistern and sylvian fissure that was slightly more prominent on the left side. Cerebral angiographic studies
Discussion
Aneurysms arising from the dorsal wall of the ICA are quite rare; they are reported to comprise 0.3% to 1% of all intracranial aneurysms or 0.9% to 6.5% of aneurysm of the ICA [15]. These aneurysms have been classified into two groups according to shape: one is a small hemispherical bulge that is called “blood blister–like aneurysm” (BBA) [1] and the other is a saccular type aneurysm. A BBA is also called a semifusiform aneurysm [7], [11] or a blister-like aneurysm [5]. Blister-like aneurysms
Conclusion
We have successfully used a technique of direct suture of the blister-like aneurysm in the ICA followed by clip reinforcement and circumferential wrapping. This method can be a useful treatment option for these fragile aneurysms in cases where other options, such as direct clips and encircling clips (which are not generally available in modern aneurysm clip trays), may be impossible. Aneurysmal rupture at the neck of the vessel does occur occasionally and can be treated using the described
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Cited by (52)
Techniques and long-term outcomes of Y-shaped autologous dura mater wrap-clipping of blood blister-like aneurysms
2022, Clinical Neurology and NeurosurgeryMicrosuturing Technique for the Treatment of Blood Blister Aneurysms: A Series of 7 Cases
2020, World NeurosurgeryCitation Excerpt :To date, few reports have explored the use of MST for the treatment of BBAs (Table 2).37-39 Some studies have reported on direct suturing, although this approach is usually recommended as a remedy for intraoperative rupture.28,33,40,41 First, this method is required only for the short period during which temporary occlusion of the parent artery is applied for repair, and this helps to avoid ischemic complications.
Outcome of a Blood Blister-Like Aneurysm Treated by Clip-Reinforced Wrapping Technique Using Y-Shaped Temporalis Fascia for Perforator Protection
2019, World NeurosurgeryCitation Excerpt :According to the literature, many wrapping materials, such as gauze,22 Gore-Tex,10 polytetrafluoroethylene,8 cellulose fabric,9 Bemsheets,11 and silicon sheets,12 have been used, but all of these materials are artificial. Their lack of biological activity may result in a foreign-body granuloma to stenose the parent artery, leading to neurologic deficits.12,22-24 For this reason, we used autologous temporalis fascia as a wrapping material, which exhibits good biological activity.
Comparison of Dolenc and pterional approach in the microsurgery for blood blister-like aneurysms (BBAs) of internal carotid artery
2019, Journal of Clinical NeuroscienceCurrent trends in the surgical management of blister aneurysms. An illustrative case series
2018, Clinical Neurology and Neurosurgery