Supraclinoid internal carotid artery blister-like aneurysms:hypothesized pathogenesis and microsurgical clipping outcomes

作     者：Shanwen Chen Xin Chen Bo Ning Yong Cao Shuo Wang Shanwen Chen;Xin Chen;Bo Ning;Yong Cao;Shuo Wang

作者机构：Department of Neurosurgerythe Hospital of Shunyi DistrictNo.3 Guangming Nan StreetShunyi DistrictBeijing 101300China Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityChina National Clinical Research Center for Neurological DiseasesNo.119 South 4th Ring West RoadFengtai DistrictBeijing 100050China Department of NeurosurgeryGuangzhou Red Cross HospitalJinan UniversityNo.396 Tongfu Zhong RoadHaizhu DistrictGuangzhou 510220GuangdongChina 

出 版 物：《Chinese Neurosurgical Journal》 (中华神经外科杂志（英文）)

年 卷 期：2022年第8卷第1期

页      面：16-25页

核心收录：

学科分类：1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 10[医学] 1009[医学-特种医学] 

基　　金：No funding was obtained or used in the production of this manuscript. 

主　　题：Blister-like aneurysm Internal carotid artery Microsurgical clipping Morphology Prognosis 

摘      要：Background:Blister-like aneurysms(BLAs)on the supraclinoid segment of the internal carotid artery(ICA)are an enigma of cerebrovascular disease.Neither has a definite pathogenesis been so far identified,nor have uniform treatment guidelines been established for them.Our aim was to develop a hypothesis regarding the evolution of BLAs according to their macroscopic morphologies and to evaluate the efficacy of microsurgical clipping.Methods:The clinical data and morphological features of 15 consecutive patients with 16 BLAs on the supraclinoid ICA were retrospectively reviewed.The treatment strategies were analyzed,and functional outcomes were evaluated using the modified Rankin scale(mRS).Favorable outcomes were defined as a mRS score of 0-2.Results:Morphologically,aneurysm growth with expansion of the aneurysm neck before the surgical procedure occurred in two ruptured and one unruptured aneurysm.Daughter bleb formation was observed in two ruptured and five unruptured aneurysms.A varied degree of parent artery sclerosis was observed in nine patients.Thirteen patients were treated with direct surgical clipping,one patient was treated with clipping and wrapping,and the remaining patient was treated with an encircling clipping graft.Favorable and unfavorable outcomes were observed in 13 and two cases,respectively.Follow-up angiograms revealed 4 cases of stenosis with respective degree of mild,30%,50%,and 80%without any neurological dysfunction.Conclusions:We suggest a hypothesis that BLAs on the supraclinoid ICA may share different evolving mechanisms between ruptured and unruptured lesions.A majority of them can be reliably and safely obliterated by direct clipping technique,except for the aneurysms accompanied with severely atherosclerotic parent walls.