Abstract
Blood blister-like aneurysms (BBAs) were considered a therapeutic challenge for both microsurgeons and endovascular therapists. While a great deal of efforts had been put to refining the treatment of BBAs, the diagnostic criteria had not been established yet. In this study, we reviewed data of 43 suspicious, small (< 1 cm), broad-necked aneurysms at supraclinoid segment of internal carotid artery (ICA) in 41 patients who had been treated with microsurgery in our hospital during the past 5 years. Diagnosis of BBAs and non-blister aneurysms was based on intraoperative findings. Epidemiological, clinical, and radiological features of BBAs and non-blister aneurysms were compared. Subtypes of BBAs were also compared. Discriminant analysis was used to generate a differentiating model for BBAs. Seventeen aneurysms were diagnosed as BBAs and 26 were diagnosed as non-blister aneurysms. No significant difference regarding age, gender, association of multiple aneurysms, or location on ICA was found between the groups. Dome/neck ratio and distal angle (intersection angle of aneurysm with ICA, distal to ophthalmic artery branching site) of BBAs were smaller than those of non-blister aneurysms (P = 0.009 and P = 0.002). A discriminant function including aforementioned factors with an overall accuracy of 76.2% was yielded (P = 0.005). BBAs and non-blister aneurysms were difficult to differentiate by clinical and radiological features as they share many characteristics in common. Dome/neck ratio < 1 did not guarantee accurate diagnosis of BBAs. A discriminant function incorporating dome/neck ratio and degree of distal angle as factors might increase the accuracy of pre-surgical diagnosis of BBAs.
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References
Abe M, Tabuchi K, Yokoyama H, Uchino A (1998) Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 89:419–424. https://doi.org/10.3171/jns.1998.89.3.0419
Bojanowski MW, Weil AG, McLaughlin N, Chaalala C, Magro E, Fournier JY (2015) Morphological aspects of blister aneurysms and nuances for surgical treatment. J Neurosurg 123:1156–1165. https://doi.org/10.3171/2014.11.jns141004
Cinar C, Oran I, Bozkaya H, Ozgiray E (2013) Endovascular treatment of ruptured blister-like aneurysms with special reference to the flow-diverting strategy. Neuroradiology 55:441–447. https://doi.org/10.1007/s00234-013-1136-y
da Silva JC, Faquini IV, Kitamura MAP, de Azevedo HRC (2008) Internal carotid artery blood blister-like aneurysm. Arq Neuropsiquiatr 66:563–565
Day AL (1990) Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72:677–691. https://doi.org/10.3171/jns.1990.72.5.0677
Gonzalez AM, Narata AP, Yilmaz H, Bijlenga P, Radovanovic I, Schaller K, Lovblad KO, Pereira VM (2014) Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol 83:197–205. https://doi.org/10.1016/j.ejrad.2013.09.017
Ishikawa T, Nakamura N, Houkin K, Nomura M (1997) Pathological consideration of a “blister-like” aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery 40:403–405. https://doi.org/10.1097/00006123-199702000-00038
Kantelhardt SR, Archavlis E, Giese A (2016) Combined suture and clipping for the reconstruction of a ruptured blister-like aneurysm. Acta Neurochir 158:1907–1911. https://doi.org/10.1007/s00701-016-2919-9
Kim JH, Kwon TH, Kim JH, Park YK, Chung HS (2006) Internal carotid artery dorsal wall aneurysm with configurational change: are they all false aneurysms? Surg Neurol 66:441–443. https://doi.org/10.1016/j.surneu.2005.12.030
Konczalla J, Gessler F, Bruder M, Berkefeld J, Marquardt G, Seifert V (2017) Outcome after subarachnoid hemorrhage from blood blister-like aneurysm rupture depends on age and aneurysm morphology. World Neurosurg 105:944–951.e941. https://doi.org/10.1016/j.wneu.2017.06.129
Mitha AP, Spetzler RF (2010) Blister-like aneurysms: an enigma of cerebrovascular surgery. World Neurosurg 74:444–445. https://doi.org/10.1016/j.wneu.2010.10.006
Nakagawa F, Kobayashi S, Takemae T, Sugita K (1986) Aneurysms protruding from the dorsal wall of the internal carotid-artery. J Neurosurg 65:303–308. https://doi.org/10.3171/jns.1986.65.3.0303
Ogawa A, Suzuki M, Ogasawara K (2000) Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery 47:578–583. https://doi.org/10.1097/00006123-200009000-00008
Peschillo S, Cannizzaro D, Caporlingua A, Missori P (2016) A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms. Am J Neuroradiol 37:856–861. https://doi.org/10.3174/ajnr.A4606
Peschillo S, Cannizzaro D, Di Stasio E, Caporlingua A, Missori P (2016) Integrative analysis of 334 patients with blister-like aneurysms. Am J Neuroradiol 37:E38–E38. https://doi.org/10.3174/ajnr.A4732
Regelsberger J, Matschke J, Grzyska U, Ries T, Fiehler J, Koppen J, Westphal M (2011) Blister-like aneurysms—a diagnostic and therapeutic challenge. Neurosurg Rev 34:409–415. https://doi.org/10.1007/s10143-011-0313-x
Rouchaud A, Brinjikji W, Cloft HJ, Kallmes DF (2015) Endovascular treatment of ruptured blister-like aneurysms: a systematic review and meta-analysis with focus on deconstructive versus reconstructive and flow-diverter treatments. Am J Neuroradiol 36:2331–2339. https://doi.org/10.3174/ajnr.A4438
Sim SY, Shin YS, Cho KG, Kim SY, Kim SH, Ahn YH, Yoon SH, Cho KH (2006) Blood blister-like aneurysms at nonbranching sites of the internal carotid artery. J Neurosurg 105:400–405. https://doi.org/10.3171/jns.2006.105.3.400
Szmuda T, Sloniewski P, Waszak PM, Springer J, Szmuda M (2016) Towards a new treatment paradigm for ruptured blood blister-like aneurysms of the internal carotid artery? A rapid systematic review. J Neurointerv Surg 8:488–494. https://doi.org/10.1136/neurintsurg-2015-011665
Tomasello A, Romero N, Aixut S, Miquel MA, Macho JM, Castano C, Coscojuela P, Lemus M, Aja L, Roman LS, Blasco J, Rovira A (2016) Endovascular treatment of intracraneal aneurysm with pipeline embolization device: experience in four centres in Barcelona. Neurol Res 38:381–388. https://doi.org/10.1080/01616412.2016.1155335
Wrobel CJ, Taubman K (2000) Blood-blister-like aneurysms. J Neurosurg 92:1076–1076
Yanaka K, Meguro K, Nose T (2002) Repair of a tear at the base of a blister-like aneurysm with suturing and an encircling clip: technical note. Neurosurgery 50:218–221. https://doi.org/10.1097/00006123-200201000-00037
Yang L, Huang X, Tan X, Zhou H, Bai HX (2016) Integrative analysis of 334 patients with blister-like aneurysms. Am J Neuroradiol 37:E37–E37. https://doi.org/10.3174/ajnr.A4709
Yu B, Zheng J, Hong Y, Chen LY, Xi Z, Yu MJ, Que ZY, Liu YH (2016) Stent-assisted coil embolization of ruptured supraclinoid blood blister-like aneurysm of internal carotid artery. Turk Neurosurg 26:219–222. https://doi.org/10.5137/1019-5149.jtn.7657-12.2
Funding
This study was funded by the National Natural Science Foundation of China (H090681571110 and 81371292 to Y.L. Zhao).
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The study was approved by the institutional review board of Beijing Tiantan Hospital, Capital Medical University.
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All patients included in this study had consent with their information being used for clinical investigation anonymously.
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Zhao, Y., Zhang, Q., Wang, S. et al. Comparison of radiological and clinical characteristics between blood blister-like aneurysms (BBAs) and non-blister aneurysms at the supraclinoid segment of internal carotid artery. Neurosurg Rev 42, 549–557 (2019). https://doi.org/10.1007/s10143-018-1002-9
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DOI: https://doi.org/10.1007/s10143-018-1002-9