Microsuturing Technique for the Treatment of Blood Blister Aneurysms: A Series of 7 Cases.

Abstract

A blood blister aneurysm (BBA) is an abnormal bulge at the nonbranching point of a vessel. However, the optimal treatment strategy for this formidable disorder remains unknown. The aim of this study was to evaluate the safety and validity of using a direct microsurgical repair technique in BBAs. Direct microsuturing of aneurysms was performed with nylon thread in 7 patients from 2014-2018. Postoperative angiography was used to confirm the obliteration of the aneurysms and the absence of stenosis of the parent artery. Neurologic function was assessed by the modified Rankin Scale. Two male and 5 female patients with a mean age of 43.7 years (range, 29-62 years) were assessed. Subarachnoid hemorrhage occurred in 6 patients, including 4 patients with Hunt-Hess grade II and 2 patients with grade III. BBAs of the internal carotid artery were observed in 3 patients, BBAs of the middle cerebral artery trunk were observed in 2 patients, and a BBA of the anterior communicating artery was observed in 1 patient. One BBA of the anterior communicating artery in 1 patient was detected incidentally during the resection of a craniopharyngioma. All BBAs were closed with blood-tight sutures via standard frontotemporal craniotomies. Postoperatively, all BBAs were completely eliminated from the circulation without stenosis of the sutured parent vessel. The proposed microsuture technique appears to be a safe, cost-effective, durable treatment for BBAs in the anterior circulation, and should be a part of the arsenal of neurosurgical practitioners who treat anterior circulation BBAs.