title: Oblique Clip Technique via Anterior Temporal Approach for Blood Blister Aneurysm of Distal Portion of Internal Carotid Artery.
abstract: BACKGROUND
  Blood blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging vascular lesions for neurosurgeons because they are fragile and difficult to clip. They are commonly found at the dorsal wall of the ICA. Trapping is an alternative for these lesions, accompanied by vascular reconstruction. However, they are sometimes close to the posterior communicating artery and anterior choroidal artery.
  
  
  METHODS
  A 30-year-old man presented with subarachnoid hemorrhage caused by rupture of a BBA in the right distal ICA. After construction of a high-flow bypass, the BBA was accessed via the standard pterional approach to end only in proximal clipping. Two weeks later, the remnant of the BBA showed a tendency to grow. Therefore, the anterior temporal approach was successfully used to obliterate the BBA using an oblique clip technique under direct inspection of patency of the perforators.
  
  
  CONCLUSIONS
  The anterior temporal approach to a BBA in the distal ICA is amenable to application of the oblique clip technique, which can provide direct inspection of the perforators emanating from the posteromedial wall of the ICA as well as obliteration of the pathologic wall. Furthermore, less retraction of the frontal lobe is also reasonable for avoidance of premature rupture of a fragile BBA.
authors.affiliation: Department of Neurosurgery, Ohnishi Neurological Center, Akashi, Hyogo, Japan.
authors.forename: Pritam
authors.initials: P
authors.lastname: Gurung
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan. Electronic address: myasushi@naramed-u.ac.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Motoyama
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hun Soo
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hironaka
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Young Su
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Ohnishi Neurological Center, Akashi, Hyogo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ohnishi
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000328:Adult; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Anterior temporal approach; Blood blister aneurysm; Oblique clip technique