• Hao Chen, Rudong Chen, Hongkuan Yang, Hua Li, Junhong Wang, and Jiasheng Yu.
• Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030 P.R. China.
• World Neurosurg. 2019 Apr 12.

BackgroundThe optimal approach of blood blister-like aneurysms (BBAs) is debated. Wrapping has been reported to be an effective strategy, but artificial materials were often used. In addition, perforator protection was difficult using this technique. In this case, we report a ruptured BBA of the left internal carotid artery (ICA) treated with a clip-reinforced wrapping technique using a Y-shaped autologous temporalis fascia to protect the posterior communicating artery (PComA). The outcome was favorable.CaseDescription: A 48-year-old female was admitted for subarachnoid hemorrhage. Digital subtraction angiography (DSA) revealed a BBA located opposite the PComA origin. A frontotemporal craniotomy was performed. The temporalis fascia was isolated from the temporalis muscle, and then tailored into a Y shape for the PComA to pass through. The diseased segment and the BBA were then wrapped by the Y-shaped temporalis fascia circumferentially. Two clips were applied to the fascia in order to reinforce the wrapping to fit snugly enough around the parent artery subsequently. DSA and computed tomography angiography (CTA) scan follow-up post-operation showed that the BBA had not recurred, the supraclinoid segment of the left ICA had reconstructed well, and the PComA was unobstructed. The patient recovered without any sequelae during the 1-year follow-up period.ConclusionsClip-reinforced wrapping technique using a Y-shaped temporalis fascia may be an effective method for treating BBAs located opposite the PComA origin. Long-term follow-up and large sample-size studies, however, are necessary to validate this approach.Copyright © 2019. Published by Elsevier Inc.

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