異なる手術手技で治療し得た破裂内頚動脈血豆状動脈瘤の2例

抄録

We report 2 cases with subarachnoid hemorrhage (SAH) secondary to ruptured blood-blister aneurysms (BBAs) originating from the anterior wall of the internal carotid artery (ICA).
Case 1: A 56-year-old man was transferred to our hospital with disturbed consciousness following a severe headache. Computed tomography (CT) showed diffuse subarachnoid hemorrhage, and cerebral angiography demonstrated a BBA originating from the anterior wall of the left ICA. We performed left ICA trapping with a high-flow bypass. His postoperative course was uneventful, and he was discharged without any neurological deficits.
Case 2: A 49-year-old man was transferred to our hospital with disturbed consciousness. Although CT showed diffuse SAH, using cerebral angiography, we could not identify any aneurysms. CT repeated 16 days after admission revealed a BBA originating from his right ICA. We decided to perform direct neck clipping because we could identify the neck of the aneurysm. Direct neck clipping of the aneurysm was performed without any complications. The patient was discharged without neurological deficits. Although the treatment of BBAs is usually difficult, an individualized strategy should be considered in patients presenting with BBAs.