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

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.