The Journal of Cerebrovascular and Endovascular Neurosurgery

Abstract - Case Report

J Cerebrovasc Endovasc Neurosurg. 2021 23(3): 245-250

Slip Clip after successful microsurgery of a blister aneurysm: Should bypass always be the first option?

Aline Lariessy Campos Paiva, Guilherme Brasileiro de Aguiar, Juan Antonio Castro Flores, José Carlos Esteves Veiga

Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences. São Paulo (SP), Brazil

Blood Blister-like aneurysms are intracranial non-saccular aneurysms with higher rupture risk due to its fragile wall. Diagnosis is performed in the acute phase of a subarachnoid hemorrhage. There are several treatment options based on reconstructive or deconstructive techniques. This paper aims to discuss the limitations of microsurgery clipping for a ruptured blister aneurysm. We report on a case of a female patient presented with a Fisher III subarachnoid hemorrhage. Cerebral angiography revealed an internal carotid artery blister aneurysm. Initially microsurgery clipping was successfully performed. However, after a few days the patient presented new subarachnoid hemorrhage. The new cerebral angiography showed growth of the previously clipped aneurysm, with displacement of the clip from the position adjacent to the artery. High-flow bypass was performed obtaining definitive treatment. This is a definitive approach for blister aneurysms. If microsurgery clipping is chosen, a strict follow-up is required due to the dynamic nature of this lesion and the chance of re-bleeding even after successfully clipping.

Key words : Brain aneurysm, Cerebral revascularization, Subarachnoid hemorrhage, Microsurgery