Blister-like aneurysms--a diagnostic and therapeutic challenge.
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Blister-like aneurysms--a diagnostic and therapeutic challenge. / Regelsberger, Jan; Matschke, Jakob; Grzyska, Ulrich; Ries, Thorsten; Fiehler, Jens; Köppen, Johannes; Westphal, Manfred.
in: NEUROSURG REV, Jahrgang 34, Nr. 4, 4, 2011, S. 409-416.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Blister-like aneurysms--a diagnostic and therapeutic challenge.
AU - Regelsberger, Jan
AU - Matschke, Jakob
AU - Grzyska, Ulrich
AU - Ries, Thorsten
AU - Fiehler, Jens
AU - Köppen, Johannes
AU - Westphal, Manfred
PY - 2011
Y1 - 2011
N2 - Blister-like internal carotid artery (ICA) aneurysms are known for their fragile and thin-walled morphology associated with a high risk of intraprocedural rupture. Neurosurgical and endovascular options are illustrated on three exemplary cases reviewing the diagnostic and therapeutic implications of these special aneurysms. A 49-year-old woman was admitted with subarachnoid hemorrhage (SAH) in which angiography showed a broad-based, small bulging ectasy of the terminal ICA segment. On the attempt of surgical clipping, the aneurysm ruptured leaving a tear in the ICA. After temporary clipping, the rims of the tear were approximated by sutures. Sufficient closure of the remaining leakage was achieved by circumferential wrapping which was secured by two clips. Postoperative angiography confirmed stenosis of the tightened ICA and patient recovered without neurological deficit. Surgical attempt on a second case with bulging of the C4-segment topped by a small aneurysm was fatal due to extensive laceration of the basal ICA intraoperatively. Endovascular stenting was the choice of treatment in a third SAH patient in which angiography was suspicious of a blister-like ICA aneurysm. Six-month follow-up was uneventful; the patient recovered well and further growth of bulging was not seen. Reviewing the literature, blister-like aneurysms tend to arise at uncommon sites not located at the arterial branches. Small and broad-based bulges with or without true saccular aneurysms have to be assessed as characteristic features of blister-like aneurysms. Rupture of the aneurysm involving the carrying artery has to be considered during therapeutic attempts, in which urgent strategies have to be kept in reserve preventing fatal outcome. Blister-like aneurysms is a hazardous affair for neurosurgeons and neuroradiologists as their fragile structure most likely will lead to intraoperative rupture. If endovascular treatment is not promising, wrapping and revascularization techniques come true to still be an important part of the neurosurgeons toolbox for reconstructing a vessel lumen and preserving a sufficient cerebral blood flow.
AB - Blister-like internal carotid artery (ICA) aneurysms are known for their fragile and thin-walled morphology associated with a high risk of intraprocedural rupture. Neurosurgical and endovascular options are illustrated on three exemplary cases reviewing the diagnostic and therapeutic implications of these special aneurysms. A 49-year-old woman was admitted with subarachnoid hemorrhage (SAH) in which angiography showed a broad-based, small bulging ectasy of the terminal ICA segment. On the attempt of surgical clipping, the aneurysm ruptured leaving a tear in the ICA. After temporary clipping, the rims of the tear were approximated by sutures. Sufficient closure of the remaining leakage was achieved by circumferential wrapping which was secured by two clips. Postoperative angiography confirmed stenosis of the tightened ICA and patient recovered without neurological deficit. Surgical attempt on a second case with bulging of the C4-segment topped by a small aneurysm was fatal due to extensive laceration of the basal ICA intraoperatively. Endovascular stenting was the choice of treatment in a third SAH patient in which angiography was suspicious of a blister-like ICA aneurysm. Six-month follow-up was uneventful; the patient recovered well and further growth of bulging was not seen. Reviewing the literature, blister-like aneurysms tend to arise at uncommon sites not located at the arterial branches. Small and broad-based bulges with or without true saccular aneurysms have to be assessed as characteristic features of blister-like aneurysms. Rupture of the aneurysm involving the carrying artery has to be considered during therapeutic attempts, in which urgent strategies have to be kept in reserve preventing fatal outcome. Blister-like aneurysms is a hazardous affair for neurosurgeons and neuroradiologists as their fragile structure most likely will lead to intraoperative rupture. If endovascular treatment is not promising, wrapping and revascularization techniques come true to still be an important part of the neurosurgeons toolbox for reconstructing a vessel lumen and preserving a sufficient cerebral blood flow.
KW - Adult
KW - Humans
KW - Female
KW - Middle Aged
KW - Tomography, X-Ray Computed
KW - Postoperative Care
KW - Carotid Artery Diseases/diagnosis/therapy
KW - Carotid Artery, Internal/surgery
KW - Cerebral Angiography
KW - Endovascular Procedures/methods
KW - Headache/etiology
KW - Intracranial Aneurysm/diagnosis/therapy
KW - Nausea/etiology
KW - Neurosurgical Procedures/methods
KW - Vomiting/etiology
KW - Adult
KW - Humans
KW - Female
KW - Middle Aged
KW - Tomography, X-Ray Computed
KW - Postoperative Care
KW - Carotid Artery Diseases/diagnosis/therapy
KW - Carotid Artery, Internal/surgery
KW - Cerebral Angiography
KW - Endovascular Procedures/methods
KW - Headache/etiology
KW - Intracranial Aneurysm/diagnosis/therapy
KW - Nausea/etiology
KW - Neurosurgical Procedures/methods
KW - Vomiting/etiology
M3 - SCORING: Journal article
VL - 34
SP - 409
EP - 416
JO - NEUROSURG REV
JF - NEUROSURG REV
SN - 0344-5607
IS - 4
M1 - 4
ER -
