Microsurgical versus Endovascular Treatments for Blood-Blister Aneurysms of the Internal Carotid Artery: A Retrospective Study of 83 Patients in a Single Center

Ren, Yanming; Liu, Lun-Xin; Sun, Hong; Liu, Yi; Li, Hao; Ma, Lu; Zhang, Changwei; Xie, Xiaohua; He, Min; You, Chao; Li, Jin

doi:10.1016/j.wneu.2017.10.048

Cited by 20 publications

(21 citation statements)

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“…The ideal treatment of an intracranial aneurysm is to obliterate it, while flow in the vessels associated with the aneurysm is maintained. They can be occluded using surgical techniques such as direct clipping, trapping, wrapping and bypass (2,(5)(6)(7)(8)10,(15)(16) .…”

Section: Treatment Of Blister-like Aneurysmmentioning

confidence: 99%

“…Most authors debate about all these characteristics, without a clear homogeneous opinion. Shah at al, 2017 (12) and Meling, 2017 (13) performed meta-analysis, while Ren at al, 2018 (2) performed a retrospective study, concluding that surgery has superior obliteration rates and similar neurological outcomes -comparing to the endovascular treatment -coming at the price of higher complication rate mostly because of higher rupture rate, vasospasm, hydrocephalus and infarction. Endovascular management offers superior safety, but higher retreatment rates and lower obliteration.…”

Section: Treatment Of Blister-like Aneurysmmentioning

confidence: 99%

“…Blister aneurysms are rare brain vascular lesions of uncertain pathogenesis (1) . Overall, they represent 0.3% -1.0% of all intracranial aneurysms and 0.9% -6.5% of all ruptured intracranial aneurysms (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) . They are associated with high morbidity and mortality (9,12,13) .…”

Section: Introductionmentioning

confidence: 99%

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Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

Aguiar

Santos

et al. 2019

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introduction: Blister aneurysms are of uncertain pathogenesis and are a vascular lesion located in the brain. Overall, they represent 0.3% - 1.0% of all intracranial aneurysms and 0.9% - 6.5% of ruptured intracranial aneurysms. They are associated with high morbidity and mortality. Even with the first description being from 1969, there is still debate in the literature about which type of treatment is the best: surgical or endovascular. In this review, we focus on the surgical management. Method: The authors performed a review of available surgical techniques used for blood blister-like aneurysms treatment. Pubmed database was used as search source introducing blister-like aneurysm and blister aneurysms as keywords. The most relevant articles and those that focused on surgical treatment techniques were selected. Discussion: The most used surgical methods are clipping, trapping, wrapping and bypass. As main features of each technique, we can highlight clipping with good efficiency, when there is good neck exposure; trapping being employed in ruptured aneurysm; wrapping for avulsion and bypass that promotes vascularization to the distal territory of the aneurysm. Conclusion: The endovascular method has shown to be promising and efficient. However, different surgical techniques are still being employed based on their efficiency when facing certain surgical scenarios.Keywords: Neurosurgery, Subarachnoid hemorrhage, Intracranial aneurysm, Endovascular proceduresRESUMOIntrodução: Aneurismas cerebrais blister-like são lesões vasculares de patogenia incerta. De modo geral, representam 0.3%-1.0% de todos aneurismas intracranianos e 0.9% - 6.5% dos aneurismas intracranianos que rompem. Estão associados a alta morbimortalidade. Mesmo com a primeira descrição sendo de 1969, ainda há debate na literatura sobre qual tipo de tratamento é o melhor: cirúrgico ou endovascular. Nessa revisão, focamos no tratamento cirúrgico. Métodos: Os autores realizaram uma revisão das técnicas cirúrgicas utilizadas para tratamento de aneurismas blister-like. A plataforma Pubmed foi utilizada para a pesquisa das palavras chaves “blister-like aneurysm” e “blister aneurysm”. Os artigos de maior relevância e aqueles que enfatizam as técnicas cirúrgicas foram selecionados. Discussão: Os métodos cirúrgicos empregados são clipagem, trapping, wrapping e bypass. Quanto às características de cada método, podemos salientar a eficácia da clipagem, quanto melhor for a exposição do aneurisma; o uso do trapping em situações de rompimento do aneurisma; wrapping para casos em que houve avulsão do aneurisma e by-pass que promove a vascularização distal ao aneurisma. Conclusão: O método endovascular tem se mostrado promissor e efetivo. No entanto, as diferentes técnicas cirúrgicas ainda são empregadas e defendidas devido a sua eficiência frente certos cenários cirúrgicos.Descritores: Neurocirurgia, Hemorragia subaracnóidea, Aneurisma intracraniano, Procedimentos endovasculares

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Section: Treatment Of Blister-like Aneurysmmentioning

confidence: 99%

Section: Treatment Of Blister-like Aneurysmmentioning

confidence: 99%

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Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

Aguiar

Santos

et al. 2019

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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“…Significant intraoperative complication rates and a high percentage of poor outcomes have been reported in several studies for the treatment of blister aneurysms with open cerebrovascular techniques. [ 8 9 10 ] Similarly, poor outcomes can also be seen in ruptured blister aneurysms that are treated with endovascular techniques such as flow diversion. [ 11 ] Based on our clinical observations, we hypothesized that one of the drivers of poor outcomes in ruptured blister aneurysms is delayed cerebral ischemia and that a patient with Fisher grade 3 subarachnoid hemorrhage (SAH) from a ruptured anterior circulation blister aneurysm has significantly higher odds of developing symptomatic delayed cerebral ischemia than a patient with a ruptured saccular aneurysm in the same category.…”

Section: Introductionmentioning

confidence: 99%

Ruptured Fisher grade 3 blister aneurysms have a higher incidence of delayed cerebral ischemia than ruptured Fisher grade 3 saccular aneurysms

et al. 2020

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BACKGROUND: Blister aneurysms are a rare subclass of aneurysms, which remain challenging to treat both with open cerebrovascular and endovascular techniques, and clinicians continue to see poor outcomes in some cases despite improvements in technology. Based on our clinical observations, we hypothesized that patients with a Fisher grade 3 subarachnoid hemorrhage (SAH) from a ruptured anterior circulation blister aneurysm are significantly more likely to develop poor outcome due to delayed cerebral ischemia than patients with a Fisher grade 3 SAH from a ruptured anterior circulation saccular aneurysm. METHODS: In this consecutive case series, we reviewed management, outcomes, and rates of delayed cerebral ischemia for all ruptured anterior circulation blister aneurysms from 2012 to 2018 at our institution and compared them to a concurrent cohort of ruptured saccular anterior circulation aneurysms. A blister aneurysm was defined as an aneurysm that arises from a nonbranching point and demonstrates hemispherical anatomy on diagnostic angiography. RESULTS: We identified 14 consecutive ruptured anterior circulation blister aneurysms. Thirteen aneurysms were treated operatively– 5 with clip remodeling and 8 with flow diversion embolization. While clip remodeling had a high intraoperative rupture rate (80%), there was only one (12.5%) intraoperative rupture with flow diversion embolization. Outcomes were worsened by delayed cerebral ischemia from vasospasm in patients with Fisher 3 hemorrhages from blister aneurysms (86%). The rate of delayed cerebral ischemia from vasospasm was significantly higher for ruptured blister aneurysms than for a concurrent cohort of ruptured saccular aneurysms (8.6%, P = 0.0001). CONCLUSION: Ruptured Fisher grade 3 anterior circulation blister aneurysms have a significantly higher incidence of delayed cerebral ischemia from vasospasm compared to saccular aneurysms, regardless of the treatment modality.

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“…The data regarding the effect of aneurysm size on rebleeding risk are variable and inconsistent [13][14][15]; however, most neurovascular authorities agree that certain features (e.g. blood-blister like carotid aneurysms) [16,17] and projections [18] leave the aneurysm at a higher risk for re-rupturing.…”

Section: Introductionmentioning

confidence: 99%

Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center

Rahmanian

Derakhshan

Alibai

2018

Iran. J. Neurosurg.

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In-hospital rebleeding and early aneurysm rupture are major causes of mortality and morbidity in aneurysmal subarachnoid hemorrhage. Rebleeding may occur at the referring hospital, during transfer or at the referral neurovascular center prior to surgical or endovascular treatment. However, there has been no report regarding the rate of in-hospital rebleeding and early aneurysm rupture at the referral centers. This study aims to clarify the incidence, significance, management, and outcome of individuals who suffer in-hospital aneurysmal rebleeding and early aneurysm rupture at the referral hospital due to anterior circulation cerebral aneurysm to the time when its neck is visualized for clipping. Methods and Materials/Patients: Among 617 patients with anterior circulation cerebral aneurysms, who underwent operation between September 2010 and September 2017 at Neurovascular Unit of Namazi Hospital (main referral neurovascular center in southern Iran), 22 suffered rebleeding since the time of neuroradiologic diagnosis of aneurysm to intraoperative visualization of aneurysm for neck dissection. A surgical technique for fast access and securing the aneurysm is described in this article, too. The patients' demographics were collected via hospital records in a retrospective fashion. Six-month functional outcome was obtained via OPD records as well as phone calls. Performing Independent t test, 1-way ANOVA, Kruskal-Wallis and Mann-Whitney tests in SPSS22, the effect of each study variable was evaluated during 6 months followup period. Results: Rebleeding occurred at different venues from CT angiography to frontal lobe retraction. Anterior communicating artery was the most common aneurysm to suffer in-hospital rebleeding and male gender was found as a risk factor. These patients have significantly higher bleeding amount and longer operative time (P<0.001), but still have a 68.2% chance of survival with good functional recovery. Earlier in-hospital rebleedings used to have worse outcomes (P=0.036 for GOS and 0.028 for mRS, respectively). Conclusion: Patients with in-hospital rebleeding and early aneurysm rupture at the referral hospitals will have a considerable chance for favorable outcome if they undergo aggressive surgical management emergently.

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Microsurgical versus Endovascular Treatments for Blood-Blister Aneurysms of the Internal Carotid Artery: A Retrospective Study of 83 Patients in a Single Center

Cited by 20 publications

References 28 publications

Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

Ruptured Fisher grade 3 blister aneurysms have a higher incidence of delayed cerebral ischemia than ruptured Fisher grade 3 saccular aneurysms

Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center

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