Mohamed Nasra1, Goran Mitreski2, Hong Kuan Kok3, Julian Maingard4, Lee-Ann Slater5, Jeremy H Russell6, Jonathan Hall7, Winston Chong8, Ashu Jhamb9, Duncan Mark Brooks10, Hamed Asadi11. 1. Melbourne School of Medicine, University of Melbourne, Parkville, Victoria, Australia. Electronic address: mnasra@student.unimelb.edu.au. 2. Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia. 3. Interventional Radiology Service, Northern Hospital, Epping, Victoria, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia. 4. School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia. 5. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia. 6. Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia. 7. Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia; Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia. 8. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia; School of Medicine, Monash University, Clayton, Victoria, Australia. 9. Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia. 10. Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia. 11. Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia; Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.
Abstract
INTRODUCTION: Blood blister aneurysms (BBAs) are rare aneurysms affecting non-branched points of intracerebral arteries. Due to their small size and fragility, BBAs are prone to rupture, and can be challenging to diagnose and treat. Several treatment options have been suggested yet there is no consensus regarding the best modality to reduce morbidity and mortality. MATERIALS AND METHODS: A systematic review of the literature was conducted searching for articles discussing the treatment of BBAs. Inclusion criteria included: articles published between January 2010 and August 2020, English language, with each paper including at least 15 patients. Studies included required detailed reporting of patient demographics, treatment, and patient outcomes (including complications, recurrence, neurologic functional status, and mortality). RESULTS AND DISCUSSION: A total of 25 studies with 883 patients were included. Most were female (n = 594, 67.3%) and aneurysms were overwhelmingly located in the supraclinoid internal carotid artery (99%). Aneurysms were variable in size and mostly presented with subarachnoid haemorrhage. Endovascular treatment (n = 518, 58.7%) was more common than microsurgery (n = 365, 41.1%) while only 2 patients were managed conservatively. Complications were more common in patients treated microsurgically. Microsurgical procedures had an unfavorable outcome (mRS 4-6, GOS 1-3) rate of 27.8% (n = 100/360) while that of endovascular procedures was 14.7% (n = 70/477). Endovascular procedures had a lower mortality rate than microsurgical interventions (8.4% vs 11%). CONCLUSION: This review demonstrates that endovascular treatment of blood blister aneurysm has reduced morbidity and mortality when compared with microsurgical treatment. Small sample sizes and substantial study heterogeneity makes strong conclusions difficult.
INTRODUCTION: Blood blister aneurysms (BBAs) are rare aneurysms affecting non-branched points of intracerebral arteries. Due to their small size and fragility, BBAs are prone to rupture, and can be challenging to diagnose and treat. Several treatment options have been suggested yet there is no consensus regarding the best modality to reduce morbidity and mortality. MATERIALS AND METHODS: A systematic review of the literature was conducted searching for articles discussing the treatment of BBAs. Inclusion criteria included: articles published between January 2010 and August 2020, English language, with each paper including at least 15 patients. Studies included required detailed reporting of patient demographics, treatment, and patient outcomes (including complications, recurrence, neurologic functional status, and mortality). RESULTS AND DISCUSSION: A total of 25 studies with 883 patients were included. Most were female (n = 594, 67.3%) and aneurysms were overwhelmingly located in the supraclinoid internal carotid artery (99%). Aneurysms were variable in size and mostly presented with subarachnoid haemorrhage. Endovascular treatment (n = 518, 58.7%) was more common than microsurgery (n = 365, 41.1%) while only 2 patients were managed conservatively. Complications were more common in patients treated microsurgically. Microsurgical procedures had an unfavorable outcome (mRS 4-6, GOS 1-3) rate of 27.8% (n = 100/360) while that of endovascular procedures was 14.7% (n = 70/477). Endovascular procedures had a lower mortality rate than microsurgical interventions (8.4% vs 11%). CONCLUSION: This review demonstrates that endovascular treatment of blood blister aneurysm has reduced morbidity and mortality when compared with microsurgical treatment. Small sample sizes and substantial study heterogeneity makes strong conclusions difficult.