title: High-flow bypass and wrap-clipping for ruptured blood blister-like aneurysm of the internal carotid artery using intraoperative monitoring of cerebral hemodynamics.
abstract: Aneurysms at non-branching sites in the supraclinoid internal carotid artery (ICA) can be classified as "blood blister-like aneurysms" (BBAs), which have blood blister-like configurations and fragile walls. While surgical treatment for the BBA in the acute stage is recommended, the optimal surgical procedure remains controversial. In the study reported here, we describe the case of a 37-year-old woman with a ruptured BBA in the ophthalmic segment of the right ICA who underwent wrap-clipping with external carotid artery-internal carotid artery bypass by intraoperative estimation of the measurement of cortical cerebral blood flow (CoBF) using a thermal diffusion flow probe. Trapping of the ICA in the acute stage of subarachnoid hemorrhage may result in ischemic complications secondary to hemodynamic hypoperfusion or occlusion of the perforating artery, and/or delayed vasospasm, even with concomitant bypass surgery. We believe that it is important to perform scheduled external carotid artery-internal carotid artery bypass before trapping of the ICA in patients with a ruptured BBA in the acute stage of subarachnoid hemorrhage and to perform wrap-clipping rather than trapping. This would provide much more CoBF if a reduction of CoBF occurs after trapping occlusion of the ICA including a ruptured BBA according to intraoperative CoBF monitoring. As far as we are aware, the case reported here is the first report on high-flow bypass and wrap-clipping for a ruptured BBA of the ICA using intraoperative monitoring of cerebral hemodynamics.
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Koji
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Saito
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000601:surgery; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D017023:Coronary Angiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D000069336:Neurovascular Coupling; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome
keywords: cortical blood flow; external carotid artery–internal carotid artery bypass; subarachnoid hemorrhage; surgery