Peschillo Simone, Missori P, Piano M, Cannizzaro D, Guidetti G, Santoro A, Cenzato M
Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, "Sapienza" University of Rome, Viale del Policlinico 155, 00100, Rome, Italy,
Neurosurg Rev. 2015 Jan;38(1):197-202; discussion 202-3. doi: 10.1007/s10143-014-0581-3. Epub 2014 Oct 18.
Blood blister-like aneurysms (BBA) were described for the first time in the 1990s, as small hemispherical bulges arising from a very fragile arterial wall. Until 2008, it was thought that this type of aneurysm almost exclusively affected the internal carotid artery, in particular, its dorsal portion. Subsequently, it was discovered that a BBA may also be present on the anterior communicating artery and on the vessels of the posterior cranial fossa. However, we found no reports in English-language literature of BBA arising from the middle cerebral artery (MCA). In this article, we present three cases of MCA BBA and discuss the unique diagnostic and therapeutic aspects of this vascular lesion. In our retrospective, multicenter review of 1330 patients with non-traumatic subarachnoid hemorrhage admitted to our services from 2000 to 2013, we found three cases (all in men) of MCA BBA. The patients' outcome was assessed using the modified Rankin scale. All three patients underwent angio-computed tomography, which did not reveal any aneurysms. Digital subtraction angiography performed within 24-48 h after admission, in all cases, demonstrated a very small aneurysm (<2 mm), with a triangular shape and abroad base, at non-branching sites of MCA. All the aneurysms were treated: one by wrapping + clipping, one by wrapping + flow-diverter stent, and one with coils. At the time of surgery, the aneurysms appeared on the surface of the parent artery without any involvement of the branches. All presented as blister-like aneurysms that were thin-walled and lacked a surgical neck. At the time of discharge, the outcome was good in one patient and poor in the other two. Our cases demonstrate that BBA can also arise from the MCA, despite the lack of previous reports of this occurrence; a BBA should be suspected, particularly in cases of non-perimesencephalic subarachnoid hemorrhage in which the presence of a MCA aneurysm is suspected but not revealed by digital subtraction angiography or angio-computed tomography.
血泡样动脉瘤（BBA）于20世纪90年代首次被描述，是一种由非常脆弱的动脉壁形成的小半球形凸起。直到2008年，人们一直认为这种类型的动脉瘤几乎只累及颈内动脉，特别是其背侧部分。随后，人们发现BBA也可能出现在前交通动脉和后颅窝血管上。然而，我们在英文文献中未发现大脑中动脉（MCA）出现BBA的报道。在本文中，我们报告了3例MCA BBA病例，并讨论了这种血管病变独特的诊断和治疗方面。在我们对2000年至2013年收治的1330例非创伤性蛛网膜下腔出血患者进行的回顾性多中心研究中，我们发现了3例MCA BBA病例（均为男性）。使用改良Rankin量表评估患者的预后。所有3例患者均接受了血管计算机断层扫描，未发现任何动脉瘤。入院后24 - 48小时内进行的数字减影血管造影在所有病例中均显示出一个非常小的动脉瘤（<2 mm），呈三角形且基底较宽，位于MCA的非分支部位。所有动脉瘤均接受了治疗：1例采用包裹 + 夹闭术，1例采用包裹 + 血流导向支架置入术，1例采用弹簧圈栓塞术。手术时，动脉瘤出现在母动脉表面，未累及分支。所有病例均表现为薄壁且无手术颈部的泡状动脉瘤。出院时，1例患者预后良好，另外2例患者预后较差。我们的病例表明，尽管此前缺乏这种情况的报道，但BBA也可起源于MCA；应怀疑存在BBA，特别是在怀疑存在MCA动脉瘤但数字减影血管造影或血管计算机断层扫描未显示的非脑池周围蛛网膜下腔出血病例中。
