Surgical management of blood blister-like aneurysms of the internal carotid artery.

Objective: To present a review of the literature and a case series of blood blister-like aneurysms (BBA) to show that an adapted direct surgical approach enables treatment of BBA with a low complication rate.

Methods: A retrospective review was performed of patients treated for a ruptured BBA of the internal carotid artery (ICA) at Hôpital Notre-Dame from 2005-2009. Clinicoradiologic data and intraoperative videos were analyzed. Outcome was assessed using the modified Rankin scale (mRS).

Results: This series includes 7 patients (4 women and 3 men) with a mean age of 44.7 (range 30-61). All patients presented with subarachnoid hemorrhage (SAH). Four angiograms were initially negative. Diameter of BBA ranged from 1.1-8.2 mm. No intraoperative or postoperative aneurysm rupture occurred in this series. Although angiograms showed expected mild stenosis of the ICA after clipping, no clinical or radiologic cerebral infarctions were observed. The outcome was favorable in all patients.

Conclusions: Recognition of BBA is essential for proper management. An appropriate neurosurgical strategy has enabled a significant reduction in perioperative aneurysm rupture compared with previous reports and obtains excellent functional results.