Suturing and Dural Wrapping for a Blood Blister-Like Aneurysm on the Supraclinoid Segment of the Internal Carotid Artery due to Dissection.

Abstract

Internal carotid artery (ICA) reconstruction is still the most effective treatment for a blood blister-like aneurysm (BBA) on the supraclinoid segment of the ICA, and clipping after wrapping has the most precise effects. However, the materials used are most often artificial. This study examined the use of autologous dura to replace the artificial materials used for wrapping after suturing a BBA. A 38-year-old man was hospitalized for subarachnoid hemorrhage. Computed tomography angiography of the head and digital subtraction angiography showed a BBA on the dorsal supraclinoid segment of the ICA. A right frontotemporal craniotomy with extradural resection of the anterior clinoid was adopted. The aneurysm was trapped with temporary clips and was found to be derived from dissection of the ICA. The separated adventitia and vascular wall were sutured to reconstruct the vascular wall first, and then the dura was cut and shaped to wrap the supraclinoid segment of the ICA. The dura was sutured onto the ICA wall to prevent dislocation. A 6-month follow-up digital subtraction angiography review showed that the supraclinoid segment of the ICA was well reconstructed, the vascular cavity exhibited slight stenosis, and BBA did not recur. Postoperative follow-up magnetic resonance imaging showed satisfying images. The method we adopted is new and showed satisfactory curative results, suggesting that ICA suturing with dura mater wrapping may become a method for the treatment of a BBA on the supraclinoid segment. The dura could potentially replace the artificial materials used for wrapping the ICA.