Primary treatment of a blister-like aneurysm with an encircling clip graft: technical case report.
OBJECTIVE
Blister-like aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery are a rare but important cause of subarachnoid hemorrhage. We report a case of subarachnoid hemorrhage caused by a ruptured blister-type aneurysm, review the pertinent literature, and hope to remind readers of the wisdom of the use of an encircling clip as the primary treatment of these challenging lesions.


METHODS
A 41-year-old woman presented with sudden onset of headache. An admission computed tomographic (CT) scan revealed thick and diffuse subarachnoid hemorrhage involving primarily the carotid cistern and the proximal left sylvian fissure. A cerebral angiogram was initially interpreted as absent for aneurysm, but a follow-up angiogram performed 1 week later confirmed an enlarging aneurysm.


METHODS
A craniotomy with placement of an encircling clip graft around a blister-like aneurysm was performed.


CONCLUSIONS
Although Sundt advocated the encircling clip graft for the blister-type aneurysm almost 40 years ago, use of an encircling clip graft in the treatment of blister-like aneurysms of the supraclinoid portion of the internal carotid artery seems to be reserved as a secondary or "rescue" measure in current practice. Neurosurgeons must familiarize themselves with this distinct entity (the blister-type aneurysm), recognize the possible risks associated with parallel clipping, and consider the use of an encircling clip graft as the primary treatment.
Sekula
Raymond F
RF
Department of Neurosurgery, Allegheny Neuroscience Institute/Drexel University, Pittsburgh, Pennsylvania, USA. raymondsekula@yahoo.com
Cohen
David B
DB
Quigley
Matthew R
MR
Jannetta
Peter J
PJ
D000328:Adult; D001019:Aortic Rupture / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001768:Blister / Q000473:pathology* / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013525:Surgical Instruments / Q000592:standards*; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
D014665:Vasodilator Agents