Yu-Tse Liu, Ho-Fai Wong, Cheng-Chi Lee, Chu-Mei Ku, Yi-Chou Wang, Tao-Chieh Yang
Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Br J Neurosurg. 2012 Jun;26(3):378-82. doi: 10.3109/02688697.2011.631617. Epub 2011 Nov 22.
Aneurysms at nonbranching sites in the supraclinoid internal carotid artery (ICA), known as blood blister-like aneurysms (BBAs), are rare entities and differ from saccular aneurysms. In this study, we attempt to describe our clinical experience and the outcome of treatments for BBAs.
Thirteen of 745 patients with aneurysmal subarachnoid hemorrhage (SAH) who visited our institution between March 2005 and July 2010, and were confirmed to have BBAs at nonbranching sites of the supraclinoid ICA by digital subtraction angiography (DSA) or computed tomography angiography, were followed-up. In these patients, several therapeutic managements were provided depending on their clinical condition. Data analyzed included patient age, sex, World Federation of Neurologic Surgeons (WFNS) scale, time interval from first DSA to second DSA, treatment of aneurysms, and the modified Rankin scale score at follow-up, 6 months after SAH.
Of these 13 patients, 5 underwent rapid configuration change from blood blister-like aneurysm to saccular-shaped. Different therapeutic managements were provided, including clipping on wrapping material in 2 patients, ICA trapping without extracranial-intracranial (EC-IC) bypass in 3 patients, EC-IC bypass and ICA trapping in 3 patients, transarterial endovascular therapy in 3 patients, direct clipping in 1 patient, and external ventricular drainage in 1 patient. Good clinical outcome was achieved in 4 patients, whereas the other 9 patients had moderate to severe disability due to rebleeding of aneurysms, large cerebral infarction, or severe cerebral vasospasm.
BBAs of the supraclinoid ICA have special neuroradiological and clinicopathological characteristics. Direct clipping or endovascular coil embolization along may not be sufficient and sometimes have undesirable results. ICA trapping or ligation including the lesion segment can be considered an alternative choice if the balloon occlusion test (BOT) is successful. However, if the patient does not tolerate the BOT, EC-IC bypass surgery with ICA ligation or trapping is another option.
床突上段颈内动脉（ICA）非分支部位的动脉瘤，即血泡样动脉瘤（BBAs），较为罕见，与囊状动脉瘤不同。在本研究中，我们试图描述我们对血泡样动脉瘤的临床经验及治疗结果。
对2005年3月至2010年7月间来我院就诊的745例动脉瘤性蛛网膜下腔出血（SAH）患者中的13例进行随访，这些患者经数字减影血管造影（DSA）或计算机断层血管造影证实床突上段颈内动脉非分支部位存在血泡样动脉瘤。针对这些患者，根据其临床情况采取了多种治疗措施。分析的数据包括患者年龄、性别、世界神经外科医师联合会（WFNS）分级、首次DSA至第二次DSA的时间间隔、动脉瘤治疗情况以及SAH后6个月随访时的改良Rankin量表评分。
这13例患者中，5例血泡样动脉瘤迅速转变为囊状。采取了不同的治疗措施，包括2例在包裹材料上夹闭，3例未行颅外-颅内（EC-IC）搭桥的颈内动脉夹闭，3例行EC-IC搭桥及颈内动脉夹闭，3例经动脉血管内治疗，1例直接夹闭，1例进行了脑室外引流。4例患者获得了良好的临床结局，而其他9例患者因动脉瘤再出血、大面积脑梗死或严重脑血管痉挛而出现中度至重度残疾。
床突上段颈内动脉血泡样动脉瘤具有特殊的神经放射学和临床病理特征。单纯直接夹闭或血管内弹簧圈栓塞可能并不充分，有时会产生不良后果。如果球囊闭塞试验（BOT）成功，可考虑将包括病变节段的颈内动脉夹闭或结扎作为一种替代选择。然而，如果患者不能耐受BOT，行EC-IC搭桥手术并结扎或夹闭颈内动脉是另一种选择。
