Peschillo Simone, Cannizzaro Delia, Missori Paolo, Colonnese Claudio, Santodirocco Antonio, Santoro Antonio, Guidetti Giulio
Department of Neurology and Psychiatry, Endovascular Neurosurgery, Sapienza University of Rome, Rome, Italy -
Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy.
J Neurosurg Sci. 2017 Aug;61(4):438-441. doi: 10.23736/S0390-5616.16.02937-4. Epub 2014 Jun 10.
Blood blister-like aneurysms (BBA) consist of focal wall defects covered with thin fibrous tissue correlated with the marked fragility of their wall; this concept is very important for deciding the right treatment of the latter. Until 2008, it was thought that this type of aneurysm almost exclusively affected the internal carotid artery, and in particular, of its dorsal portion. Subsequently, it was discovered that the BBA may also be present on the anterior communicating artery and on the posterior cranial fossa vessels. In this article, we present a case of anterior communicating artery (AComA) BBA and discuss the unique diagnostic and therapeutic aspects of this vascular lesion. Treatment requires an experienced team of vascular and endovascular neurosurgeons to treat this hazardous group of aneurysms; endovascular stenting techniques avoid maneuvres on the aneurysm itself and should therefore be judged as the lowest risk and first-choice procedures available. We found no reports in the English-language literature of BBA that arose from the AComA treated by a Flow-diverter stent (FDS) in the acute phase. BBA constitute technically challenging lesions that may occur at the AComA. Endovascular treatment offers a lower morbidity-mortality compared with surgical approaches; FDS appear to be a promising strategy.
血泡样动脉瘤（BBA）由覆盖着薄纤维组织的局灶性壁缺损构成，这与其壁的明显脆弱性相关；这一概念对于决定对后者的正确治疗非常重要。直到2008年，人们认为这种类型的动脉瘤几乎只影响颈内动脉，尤其是其背侧部分。随后，发现BBA也可能出现在前交通动脉和后颅窝血管上。在本文中，我们展示了一例前交通动脉（AComA）BBA病例，并讨论了这种血管病变独特的诊断和治疗方面。治疗需要经验丰富的血管和血管内神经外科医生团队来处理这类危险的动脉瘤；血管内支架技术避免了对动脉瘤本身的操作，因此应被视为风险最低的首选方法。我们在英文文献中未发现关于急性期采用血流导向支架（FDS）治疗的起源于AComA的BBA的报道。BBA在技术上是具有挑战性的病变，可能发生在AComA。与手术方法相比，血管内治疗的发病率和死亡率更低；FDS似乎是一种有前景的策略。
