Ruptured blister-like aneurysms (BBA) originating from the internal carotid artery (ICA) are known to present several challenges in treatment such as difficulties of clipping, intraoperative rupture, and postoperative rebleeding. We experienced 7 cases of ruptured BBA originating from the ICA treated with a definite strategy in the past 3 years at our institution. In this paper, we report our treatment strategy and surgical results.
We treated 7 cases between the ages of 35 and 60 years, including 3 males treated in the acute stage. Our treatment strategy is basically trapping of aneurysms with STA-proximal MCA anastomosis or high-flow bypass, a strategy that depends on the cross-flow through the anterior communicating artery. Following EC/IC bypass, we confirmed whether trapping of the aneurysm was possible or not. If intraoperative motor evoked potential (MEP) decreased or disappeared during tentative occlusion of ICA, we treated aneurysms with wrap-clipping.
Six cases were successfully treated with trapping of BBA following STA-proximal MCA anastomosis. Wrap-clipping was performed in 1 case due to reduction of MEP after occlusion of the ICA at the proximal portion of BBA. Although there were no surgical complications, 2 cases suffered symptomatic vasospasm. The outcome at 3 months after the onset was 5 mRS0, 1 mRS1, 1 mRS3.
Our treatment strategy achieved favorable clinical outcomes: 6 of 7 cases were able to be treated with trapping with STA-proximal MCA anastomosis without clipping difficulties, intraoperative rupture or postoperative rebleeding. On the other hand, 2 of 6 cases treated with trapping with STA-proximal MCA anastomosis suffered symptomatic vasospasm. Therefore, more attention must be paid to vasospasm.
