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Ruptured “blisterlike” aneurysm with a pseudoaneurysm formation requiring delayed intervention with endovascular coil embolization

Case report

Shuichi Tanoue, Hiro Kiyosue, Shunro Matsumoto, Masanori Yamashita, Hirofumi Nagatomi, and Hiromu Mori

S mall hemispherically shaped bulges from the nonbranching site of a parent artery are called “blisterlikeaneurysms. These lesions are considered to be high-risk aneurysms because of the technical difficulties associated with their surgical and endovascular treatment. 1, 3, 8, 11, 12, 16 In previous reports various surgical procedures have been described for the treatment of such aneurysms, such as by trapping, parallel clip placement, wrapping, and clip placement on wrapping. 4, 7, 10, 12, 13, 15–17 To our knowledge, only one case of a blisterlike

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Wrap-clipping with polytetrafluoroethylene for ruptured blisterlike aneurysms of the internal carotid artery

Technical note

Yoshitaka Kubo, Kuniaki Ogasawara, Nobuhiko Tomitsuka, Yasunari Otawara, Mikio Watanabe, and Akira Ogawa

V arious surgical procedures, such as parallel clipping, 9 , 10 , 15 suturing and covering the aneurysm with an encircling clip, 18 trapping with or without bypass surgery, 13 and vascular closure staple clips 17 have been used for the management of ruptured blisterlike aneurysms of the supraclinoid ICA. These types of aneurysms have also been treated with a so-called “wrap-clipping” technique, in which various wrapping materials can be used. 1 , 6 , 12 , 13 We describe a wrap-clipping technique in which PTFE is used, and present our experience in six

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Blisterlike Aneurysms

Neurosurgical Forum: Letters to the Editor To The Editor Shigeaki Kobayashi , M.D. Kazuhiko Kyoshima , M.D. Yasser Orz , M.D. Shinshu University School of Medicine Matsumoto, Japan 164 166 We read with interest the recent article by Abe, et al. (Abe M, Tabuchi K, Yokomaya H, et al: Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 89: 419–424, September, 1998). In this report the authors described the clinical course of six patients who presented with subarachnoid hemorrhage with blood blisterlike aneurysms (BBAs) arising from

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Blood blisterlike aneurysms of the internal carotid artery

Masamitsu Abe, Kazuo Tabuchi, Hiroaki Yokoyama, and Akira Uchino

P atients with spontaneous subarachnoid hemorrhage (SAH) usually have berry aneurysms or dissecting aneurysms, especially if the lesions are located in the posterior fossa. In this report, we demonstrate that another process involving the anterior wall of the internal carotid artery (ICA) also produces SAH. Our use of the term “blood blisterlike aneurysm” (BBA) refers to a small hemispherical bulge from the arterial wall. 16 Although such an aneurysm is not novel, there are only a few reports of BBAs in the English literature. 4, 7, 15 The lesion resembles a

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Direct repair of a blisterlike aneurysm on the internal carotid artery with vascular closure staple clips

Technical note

Toshiharu Yanagisawa, Kazuo Mizoi, Taku Sugawara, Akira Suzuki, Tohru Ohta, Naoki Higashiyama, Masataka Takahashi, Toshio Sasajima, and Hiroyuki Kinouchi

B listerlike aneurysms of the ICA are a special type of lesion, with an extremely thin-walled appearance including the neck of the aneurysm. 1, 4–7 These lesions are easy to rupture intraoperatively, resulting in the formation of a large defect on the ICA. In such a situation, it is very difficult to reconstruct the ICA while preserving patency of the parent artery. We report a new technique in which vascular closure staple clips are used for direct repair of the tear on a blisterlike aneurysm. Case Report History and Examination This 65-year

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Spontaneous regression of an aneurysm at a nonbranching site of the supraclinoid internal carotid artery

Case report

Takashi Ueta, Shunsuke Ichi, Takashi Ochi, and Ichiro Suzuki

follow-up DS angiogram obtained 19 days after pre- sentation, demonstrating partial obliteration of the aneurysm. Fig. 4. A follow-up DS angiogram obtained 47 days after pre- sentation, exhibiting complete regression of the aneurysm. Discussion We could not clarify whether the SAH in this patient originated due to spontaneous rupture of an existing aneurysm or trauma. The SAH might have occurred following spontaneous rupture of an existing aneurysm that had been too small to be visible on initial angiography—known as a blisterlike aneurysm

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Blister or Berry Aneurysm

Neurosurgical Forum: Letters to the Editor To The Editor A. Giancarlo Vishteh , M.D. Robert F. Spetzler , M.D. Barrow Neurological Institute Phoenix, Arizona 1062 1063 We read with great interest the article by Abe, et al. (Abe M, Tabuchi K, Yokoyama H, et al: Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 89: 419–424, September, 1998). We agree with the authors that the “blood blister” type of aneurysm represents a peculiar variant of cerebral aneurysms. Interestingly enough, Abe, et al., found all such aneurysms along the

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Blood-Blister-Like Aneurysms

. In the present case, growth probably occurred during the short interval between angiograms, similar to the experience reported by Abe, et al. 1 References 1. Abe M , Tabuchi K , Yokoyama H , et al : Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 89 : 419 – 424 , 1998 Abe M, Tabuchi K, Yokoyama H, et al: Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 89: 419–424, 1998 Neurosurgical Forum: Letters to the Editor Response Masamitsu Abe , M.D. Kazuo Tabuchi , M.D. Saga Medical School Saga, Japan We

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Anterior paraclinoid aneurysms

Roberto C. Heros

reviewed two reports for the Journal of Neurosurgery in which blisterlike aneurysms were located precisely at the same site as the aneurysms described by Kinouchi and colleagues. Surgery of blisterlike aneurysms is fraught with danger, as has been emphasized repeatedly in recent literature. 1–3 Thus it is important to differentiate regular saccular aneurysms in this location, which, as Kinouchi and colleagues have demonstrated, can be clipped satisfactorily, from the more ominous blisterlike aneurysms that generally cannot be clipped and must be treated by

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Subarachnoid hemorrhage caused by a dissecting aneurysm of the internal carotid artery

Hiroki Ohkuma, Takahiro Nakano, Hiroshi Manabe, and Shigeharu Suzuki

. Therefore, these study data indicate that dissecting aneurysms of the ICA account for at least some of the cases of SAH that are not due to rupture of saccular cerebral aneurysms and are of unverified cause. Furthermore, arterial dissection has recently been suggested as the pathogenesis of some cases of blood blisterlike aneurysms of the ICA, 1, 8 dorsal wall aneurysms of the ICA, 14, 23 and ICA trunk aneurysm. 17 Therefore, cases that are considered to be caused by arterial dissection should be recategorized as dissecting aneurysms of the ICA, because it is known