Abstract
Blood blister-like aneurysms (BBLAs) are aneurysms from the non-branching sites of the internal carotid artery (ICA). Though rare lesions, they pose a high risk of intraoperative aneurysmal rupture. Definite treatment of these types of aneurysms has been debatable, but surgical approach is the ultimate rescue treatment. Microsuture of the intraoperative ruptured BBLA has been reported scarcely in literature, but no review of these cases has ever been reported. We here present our experience of a case of BBLA intraoperative rupture requiring microsuture of the ICA and conduct meticulous review of all similar cases.
Highlights
First described by Sundt and Murphey [1], blood blisterlike aneurysms (BBLAs) or frog-eye aneurysms are frequently seen at the non-branching sites of the supraclinoid internal carotid artery
Higher incidences of BBLAs have been reported among women, on the right side, in younger patients with subarachnoid hemorrhage (SAH), associated hypertension and arteriosclerosis, or dissection of the internal carotid artery (ICA) [2, 3]
BBLAs are thin and fragile hemispherical bulges and can progress into a saccular shape. They are at high risk of recurrent hemorrhage no matter their shape or the treatment modality chosen [5]. These lesions account for 0.5–2.0 % of ruptured intracranial aneurysms and prelude unusually high morbidity and mortality rates compared with typical ruptured saccular aneurysms of the ICA [6]
Summary
First described by Sundt and Murphey [1], blood blisterlike aneurysms (BBLAs) or frog-eye aneurysms are frequently seen at the non-branching sites of the supraclinoid internal carotid artery. Higher incidences of BBLAs have been reported among women, on the right side, in younger patients with subarachnoid hemorrhage (SAH), associated hypertension and arteriosclerosis, or dissection of the internal carotid artery (ICA) [2, 3]. Their bulging appearance with a broad base ostium indicates a “sick” carotid wall segment differing from the overall group of saccular aneurysms [4]. Endovascular techniques have revolutionized the treatment of aneurysms in general, these blister-like aneurysms present a challenge because of their small size, wide necks, and fragile nature.
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