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. 2019 Jul:182:136-141.
doi: 10.1016/j.clineuro.2019.05.006. Epub 2019 May 9.

Blister aneurysms of the internal carotid artery: Surgical treatment and management outcome from a single center experience

Auricelio B Cezar-Junior  1 , Ubiratan Alves da Silva Viturino  2 , Eduardo Vieira de Carvalho Junior  3 , Igor Vilela Faquini  4 , Nivaldo S Almeida  5 , Hildo Rocha Cirne Azevedo-Filho  6
Affiliations

Blister aneurysms of the internal carotid artery: Surgical treatment and management outcome from a single center experience

Auricelio B Cezar-Junior et al. Clin Neurol Neurosurg. 2019 Jul.

Abstract

Objective: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are rare entities, but clinically important cause of subarachnoid hemorrhage (SAH). Several surgical and endovascular strategies have been attempted for these heterogeneous lesions. In this study, the authors analyzed the treatment strategy and outcomes in a series of cases of ICA blister aneurysms treated microsurgically.

Patients and methods: We retrospectively reviewed 15 consecutive cases of patients harboring ruptured BBAs, microsurgically treated at our institution between 2014 and 2018. We performed an analysis of the clinical and surgical aspects, as well as post-operative angiograms and outcomes.

Results: Fifteen patients were identified; 9 (60%) were female. The mean age of presentation was 43,8 years. Most patients presented in good clinical conditions (Hunt-Hess 1-3 = 86%). The most common Fisher grade at presentation was 3 (60% of cases). All patients underwent digital subtraction angiography (DSA), revealing broad-based aneurysms at non-branching sites on the dorsal wall of the ICA. Intraoperatively, BBAs were confirmed in all cases. The lesions were approached through pterional (11-73%) or lateral supraorbital (4-27%) craniotomy. Direct clipping was performed in all but one lesion, in which case the clip-wrapping technique was used. Final angiographic control revealed complete occlusion in 14 cases. One patient required reoperation due to residual aneurysm filling. At discharge, a good outcome (Glasgow Outcome Scale [GOS] 4 or 5) was observed in 12 (80%) patients. Three patients were discharged with a GOS of 3.

Conclusion: Blood-blister-type aneurysms are rare and challenging lesions. Preoperative knowledge and careful surgical planning can prevent poor clinical outcomes. Surgical treatment remains an effective and safe option in this context.

Keywords: Blister aneurysm; Brain aneurysm; Internal carotid artery; Subarachnoid hemorrhage; Surgical treatment.

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