J Korean Neurosurg Soc.  2014 Dec;56(6):500-503. 10.3340/jkns.2014.56.6.500.

Blood Blister-Like Aneurysm with Rupture Point Close to Origin of Anterior Choroidal Artery

• Park J

• KMID: 2191144
• DOI: http://doi.org/10.3340/jkns.2014.56.6.500

Abstract

If a ruptured blood blister-like aneurysm (BBA) arises from the lateral or superolateral wall of the internal carotid artery (ICA) at the level of the anterior choroidal artery (AChA), its proximity to the origin of the AChA presents a serious surgical challenge to preserve the patency of the AChA. Two such rare cases are presented, along with successful surgical techniques, including the application of a C-shaped aneurysm clip parallel to the ICA and a microsuture technique to repair the arterial defect. The patency of the AChA and ICA was successfully preserved without recurrence or rebleeding of the BBA during a 1-year follow-up after the operation.

Keyword

Anterior choroidal artery; Blood blister-like aneurysm; Surgical technique

MeSH Terms

Aneurysm*
Arteries*
Carotid Artery, Internal
Choroid*
Follow-Up Studies
Recurrence
Rupture*

Figure

• 

  Fig. 1 Case 1. A : Left carotid angiogram showing an ill-defined, slight bulging (arrow) in the lateral wall of the ICA at the level of the AChA. B : In-traoperative photograph showing a right-angled aneurysm clip applied parallel to the ICA to catch the edges of the arterial defect, producing mild stenosis of the ICA. C : 1-year follow-up DSA demonstrating preservation of the AChA (arrow) without recurrence of the BBA and the stenotic ICA induced by clip application. ICA : internal carotid artery, DSA : digital subtraction angiography, AChA : anterior choroidal artery, BBA : blood blister-like aneurysm.

• 

  Fig. 2 Case 2. A : A 3D reconstruction of DSA images revealing the BBA (arrow) close to the origin of the AChA (arrowheads) without relation to the AChA. B : Intraoperative photograph showing the lesioned distal ICA harboring a rupture point covered by a blood clot in the lateral wall and friable anterior and medial walls. C : Illustration demonstrating a large arterial defect and adjacent AChA in the distal ICA. D : Illustration showing severe stenosis of the distal ICA after microsuturing the arterial defect. E : Intraoperative photograph showing the AChA emitting from the stenotic distal ICA after reinforcement using an aneurysm clip. F : 6-month follow-up DSA showing the severely stenotic ICA and preservation of the patency of the AChA (arrowheads) and PCoA (arrows) without recurrence. DSA : digital subtraction angiography, BBA : blood blister-like aneurysm, AChA : anterior choroidal artery, PCoA : posterior communicating artery.

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