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Dorsal variant blister aneurysm repair
William T Couldwell1, Roukoz Chamoun
1Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA. neuropub@hsc.utah.edu
Journal of Neurosurgery
|January 19, 2012
Summary
Dorsal variant proximal carotid blister aneurysms require specific surgical approaches. A modified clip-wrap technique using polyester graft material offers a direct repair option for these challenging lesions.
Area of Science:
- Neurosurgery
- Vascular Surgery
Background:
- Dorsal variant proximal carotid blister aneurysms are rare and challenging cerebrovascular lesions.
- Preoperative recognition via angiographic imaging is crucial for effective management.
Observation:
- A young woman presented with subarachnoid hemorrhage due to a ruptured dorsal variant blister aneurysm.
- A modified clip-wrap technique utilizing woven polyester graft material was employed for direct repair.
Findings:
- The modified clip-wrap technique provides a viable strategy for direct repair of blister aneurysms.
- Intraoperative Doppler and indocyanine green angiography confirmed vessel patency post-repair.
- Somatosensory and motor evoked potential monitoring ensured neurological safety during the procedure.
Implications:
- This technique offers an alternative to artery sacrifice with or without bypass, reserving them as salvage therapies.
- Direct repair of blister aneurysms can be achieved, potentially improving patient outcomes.
- Standardized surgical protocols incorporating advanced imaging and monitoring are essential for managing these complex aneurysms.
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