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Primary Treatment of a Blister-like Aneurysm with an Encircling Clip Graft: Technical Case Report
Journal article   Open access   Peer reviewed

Primary Treatment of a Blister-like Aneurysm with an Encircling Clip Graft: Technical Case Report

Raymond F. Sekula, David B. Cohen, Matthew R. Quigley and Peter J. Jannetta
Operative neurosurgery (Hagerstown, Md.), v 59(suppl_1), pp ONS-E168-ONS-E168
01 Jul 2006
PMID: 16894653
url
https://doi.org/10.1227/01.neu.0000220058.17532.b5View
Published, Version of Record (VoR)Open Access (License Unspecified) Open

Abstract

Abstract OBJECTIVE: Blister-like aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery are a rare but important cause of subarachnoid hemorrhage. We report a case of subarachnoid hemorrhage caused by a ruptured blister-type aneurysm, review the pertinent literature, and hope to remind readers of the wisdom of the use of an encircling clip as the primary treatment of these challenging lesions. CLINICAL PRESENTATION: A 41-year-old woman presented with sudden onset of headache. An admission computed tomographic (CT) scan revealed thick and diffuse subarachnoid hemorrhage involving primarily the carotid cistern and the proximal left sylvian fissure. A cerebral angiogram was initially interpreted as absent for aneurysm, but a follow-up angiogram performed 1 week later confirmed an enlarging aneurysm. INTERVENTION: A craniotomy with placement of an encircling clip graft around a blister-like aneurysm was performed. CONCLUSION: Although Sundt advocated the encircling clip graft for the blister-type aneurysm almost 40 years ago, use of an encircling clip graft in the treatment of blister-like aneurysms of the supraclinoid portion of the internal carotid artery seems to be reserved as a secondary or “rescue” measure in current practice. Neurosurgeons must familiarize themselves with this distinct entity (the blister-type aneurysm), recognize the possible risks associated with parallel clipping, and consider the use of an encircling clip graft as the primary treatment.

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Web of Science research areas
Clinical Neurology
Surgery
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