Tekkök Ismail Hakki, Bakar Bülent
MESA Hospital, Department of Neurosurgery, Ankara, Turkey.
Turk Neurosurg. 2008 Oct;18(4):439-45.
Blister-like aneurysms are small hemispherical bulges that usually originate from the anteromedial wall of the distal internal carotid artery and cause significant subarachnoid hemorrhage. It is very important to recognize this novel lesion as a different type of aneurysm than ordinary berry aneurysms.
We report the case of a 43-year-old man who underwent a diagnostic procedure and was awaiting surgery elsewhere before being transferred to our institution. A right sided blister-like aneurysm was seen on angiograms. Although the aneurysm bled intraoperatively, 2 clips were placed with one slightly catching the medial artery wall. The outcome was excellent.
Since blister-like aneurysms are different than saccular aneurysms both morphologically and histologically, their treatment also differs making surgical exploration and standard clipping a more hazardous situation than usual. In fact, surgical decision for blister aneurysms should be individual with alternative plans in case the initial treatment strategy fails. Such a flexible strategy also necessitates preoperative cerebrovascular flow testing and a variety of additional hardware like encircling graft clips, microsutures or wrapping material ready in the operating room on top of traditional aneurysm clips.
水泡样动脉瘤是小的半球形膨出物，通常起源于颈内动脉远端的前内侧壁，并导致严重的蛛网膜下腔出血。将这种新型病变识别为与普通浆果样动脉瘤不同类型的动脉瘤非常重要。
我们报告了一名43岁男性的病例，该患者在转至我院之前已在其他地方接受了诊断性检查并等待手术。血管造影显示右侧有一个水泡样动脉瘤。尽管动脉瘤在术中出血，但放置了2个夹子，其中一个稍微夹住了内侧动脉壁。结果非常好。
由于水泡样动脉瘤在形态学和组织学上均与囊状动脉瘤不同，其治疗方法也有所不同，这使得手术探查和标准夹闭比平常更具风险。事实上，水泡样动脉瘤的手术决策应个体化，若初始治疗策略失败应有替代方案。这种灵活的策略还需要术前进行脑血管血流检测，并在手术室准备好各种额外的器械，如环绕移植夹、显微缝线或包裹材料，以及传统的动脉瘤夹。
