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Acta Neurochirurgica

, Volume 156, Issue 11, pp 2071–2077 | Cite as

How I do it: treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery by extracranial-to-intracranial bypass and trapping

  • Ulaş Cıkla
  • Christopher Baggott
  • Mustafa K. BaşkayaEmail author
How I Do it - Vascular

Abstract

Background

Blood blister-like aneurysms (BBAs) pose a significant challenge to neurosurgeons and neuro-interventionalists. These fragile broad-based aneurysms have a propensity to rupture with minimal manipulation during surgical or endovascular explorations because, unlike saccular aneurysms, they lack all layers of the arterial wall. Aneurysm trapping with extracranial-intracranial (EC-IC) bypass is a safe and durable treatment for BBAs.

Methods

We describe our technique and the guiding principles for surgical bypass and trapping of BBAs of the supraclinoid internal carotid artery (ICA).

Conclusions

Treatment of BBAs of the supraclinoid ICA remains difficult. Aneurysm trapping with EC-IC bypass treats BBAs definitively by eliminating the diseased segment of the ICA. We have found the technique and principles described here to be safe and durable in our hands.

Keywords

Blood blister-like aneurysm Bypass surgery Surgical technique 

Abbreviations

ACA

Anterior cerebral artery

AchoA

Anterior choroidal artery

BBAs

Blood blister-like aneurysms

BTO

Balloon test occlusion

EEG

Electroencephalography

ECA

External carotid artery

ICA

Internal carotid artery

ICG-VA

Indocyanine green videoangiography

MCA

Middle cerebral artery

PCA

Posterior cerebral artery

PcomA

Posterior communicating artery

RA

Radial artery

SAH

Subarachnoid hemorrhage

SCM

Sternocleidomastoid

Notes

Conflict of interest

None.

Supplementary material

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References

  1. 1.
    Kazumata K, Nakayama N, Nakamura T, Kamiyama H, Terasaka S, Houkin K (2014) Changing treatment strategy from clipping to radial artery graft bypass and parent artery sacrifice in patients with ruptured blister-like internal carotid artery aneurysms. Neurosurgery 1:66–72CrossRefGoogle Scholar
  2. 2.
    Baskaya MK, Heros RC (2004) Surgical Treatment of Aneurysms of the Supraclinoid Segment of the Internal Carotid Artery. In: LeRoux PD, Winn HR, Newell DW (eds) Management of Cerebral Aneurysms. Saunders, Philadelphia, pp 747–762Google Scholar
  3. 3.
    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 83:197–205PubMedCrossRefGoogle Scholar
  4. 4.
    Kamijo K, Matsui T (2010) Acute extracranial-intracranial bypass using a radial artery graft along with trapping of a ruptured blood blister–like aneurysm of the internal carotid artery. Clinical article. J Neurosurg 113:781–785PubMedCrossRefGoogle Scholar
  5. 5.
    Regelsberger J, Matschke J, Grzyska U, Ries T, Fiehler J, Khyper J, Westphal M (2011) Blister-like aneurysms–a diagnostic and therapeutic challenge. Neurosurg Rev 34:409–416PubMedCrossRefGoogle Scholar
  6. 6.
    Seçkin H, Avci E, Uluç K, Niemann D, Başkaya MK (2008) The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications. Neurosurg Focus 25:1–12Google Scholar
  7. 7.
    Yeon JY, Hong SC, Kim JS, Kim KH, Jeon P (2012) Unruptured non-branching site aneurysms located on the anterior (dorsal) wall of the supraclinoid internal carotid artery: aneurysmal characteristics and outcomes following endovascular treatment. Acta Neurochir (Wien) 154:2163–2171CrossRefGoogle Scholar
  8. 8.
    Shigeta H, Kyoshima K, Nakagawa F (1992) Dorsal internal carotid artery aneurysms with special reference to angiographic presentation and surgical management. Acta Neurochir (Wien) 119:42–48CrossRefGoogle Scholar
  9. 9.
    Baskaya MK, Ahmed A, Ates O, Niemann D (2008) Surgical treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery with extracranial- intracranial bypass and trapping. Neurosurg Focus 24(2):E13PubMedCrossRefGoogle Scholar
  10. 10.
    Lee JW, Choi HG, Jung JY, Huh SK, Lee KC (2009) Surgical strategies for ruptured blister-like aneurysms arising from the internal carotid artery: a clinical analysis of 18 consecutive patients. Acta Neurochir (Wien) 151:125–30CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Ulaş Cıkla
    • 1
  • Christopher Baggott
    • 1
  • Mustafa K. Başkaya
    • 1
    Email author
  1. 1.Department of NeurosurgeryUniversity of Wisconsin-Madison, School of MedicineMadisonUSA

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