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Ruptured blood blister like aneurysm: does the best therapeutic option really exist?

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Abstract

Our study aimed to evaluate the outcome of patients with ruptured blood-blister like aneurysm (BBLA) in our institution by comparing microsurgical selective treatment to endovascular treatment using flow-diverter stent (FD). Our study included 18 consecutive patients treated for BBLA between 2004 and 2020. Until 2014, microsurgery was preferred in all patients with BBLA (n = 10). Significant postoperative morbi-mortality was recorded at this time and led us to change therapeutic strategy and to favor FD as first-line treatment in all patients (n = 8). Postprocedural complications and BBLA occlusion were recorded. High WFNS score (> 2) was noted in 6 patients of microsurgical group and in 2 of endovascular group. In microsurgical group, ischemic lesions were noted in 6 patients and led to death in 3 patients. Immediate BBLA occlusion was obtained in all patients. Favorable outcome after 3 months (mRS < 3) was recorded in 4 of the 7 survivors. In endovascular group, ischemic lesions were noted in 4 patients. One patient died from early postprocedural BBLA rebleeding. Scarpa hematoma was noted in 3 patients with surgical evacuation in 1. Persistent BBLA at 3 months was recorded in 4 patients without rebleeding, but further FD was required in 1 with growing BBLA. Favorable outcome was noted in 6 of the 7 survivors. Although, rate of morbi-mortality appear lower in patients treated with FD, neurological presentation was better and BBLA diagnosis remains questionable in this group. Moreover, persistent BBLA imaging with potential risk of rebleeding after FD deserves to be discussed.

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Authors and Affiliations

  1. Department of Neurosurgery, Lille University Hospital, rue E. Laine, 59037, Lille cedex, France

    Rabih Aboukais, Antoine Devalckeneer, Philippe Bourgeois & Jean-Paul Lejeune

  2. Department of Neurosurgery, Saint-Etienne University Hospital, Saint-Priest-en-Jarez, France

    Marie Charlotte Tétard

  3. Neurosurgical Intensive Care Department, Lille University Hospital, Lille, France

    Pierre Boussemart

  4. Department of Neuroradiology, Lille University Hospital, Lille, France

    Nicolas Bricout & Xavier Leclerc

  5. Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium

    Barbara Verbraeken & Tomas Menovsky

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  1. Rabih Aboukais
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Contributions

Rabih Aboukais, MD, PhD1*, Marie Charlotte Tétard, MD2, Antoine Devalckeneer, MD1, Pierre Boussemart, MD3, Philippe Bourgeois, MD1, Nicolas Bricout, MD4, Barbara Verbraeken, MD5, Tomas Menovsky, MD, PhD5, Xavier Leclerc, MD, PhD4, Jean-Paul Lejeune MD, PhD1 contribute to collect data, to write the manuscript, to review the manuscript.

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Correspondence to Rabih Aboukais.

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Ethical approval was waived by the local Ethics Committee of University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Aboukais, R., Tétard, M.C., Devalckeneer, A. et al. Ruptured blood blister like aneurysm: does the best therapeutic option really exist?. Neurosurg Rev 44, 2767–2775 (2021). https://doi.org/10.1007/s10143-020-01463-4

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