Blister-Like Supraclinoid Internal Carotid Artery Pseudoaneurysm in a 15-Year-Old Male: Case Report and Review of the Literature

Abstract

With an incidence of less than 1–3 per million, pediatric aneurysms are rare clinical entities. A traumatic etiology is implicated in a large proportion of these cases, leading to the formation of both ‘false’ and ‘true’ aneurysms. These occur most often in the distal circulation, but have also been described in the supraclinoid distal internal carotid artery (ICA). Blood blister aneurysms are also found in this location; however, they have not been described in the pediatric population. We report the case of a 15-year-old male who presented following cranial trauma with diffuse basal subarachnoid hemorrhage and limited additional intracranial pathology. Computed tomography angiography demonstrated a small, 2-mm blister-like aneurysm arising from the dorsal surface of the left supraclinoid ICA at a non-branching site. Despite early endovascular treatment with Guglielmi detachable coils, the lesion continued to grow over subsequent studies, necessitating open surgical clipping. At the time of surgery, gross pathology of the native ICA was observed, raising the possibility of a preexisting blood-blister aneurysm. We review the epidemiology, pathophysiology and diagnostic considerations of these lesions. The endovascular and surgical management of these complex non-branching supraclinoid ICA aneurysms is also discussed.

Flow diversion with Pipeline Embolic Device as treatment of subarachnoid hemorrhage secondary to blister aneurysms: dual-center experience and review of the literature

“…Pathologically, BAs are very different from saccular aneurysms 4. Histological examination shows abrupt loss of both the intima and media 4 5. As a result, the outer wall of BAs is comprised of only adventitia and/or thrombus, often adherent to the overlying pia, essentially with the body of the aneurysm behaving like a pseudoaneurysm with no true wall structure.…”

A Rare Case of Posterior Communicating Artery Pseudoaneurysm Caused by Traumatic Head Injury

“…The time between injury and diagnosis has ranged from within 24 hours to 25 years. More than half of reported cases were diagnosed within 3 weeks [8,9]. Angiography performed the day of injury detected traumatic aneurysms in only 54% of the case.…”

“…Nonoperative management is associated with a 50% mortality rate. The reported combined morbidity and mortality rate associated with surgical management is approximately 22% [8,9].…”

Morphological aspects of blister aneurysms and nuances for surgical treatment

“…All aneurysms in our series and those we found in the literature could be readily classified into 1 of these 4 types (Table 2). 1,2,4,6,7,9,10,[12][13][14][18][19][20][23][24][25][26][27][28][29][31][32][33]35,[39][40][41][42][43][44]47,[49][50][51][52]57 Each type presented distinctive surgical pitfalls, which required a different clip placement technique.…”