• Moon-Soo Han, Sung-Pil Joo, Seung-Hoon Jung, and Tae-Sun Kim.
• Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hospital & Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757, Republic of Korea.
• Acta Neurochir (Wien). 2015 Nov 1; 157 (11): 1849-54.

BackgroundBlood blister-like aneurysms (BBAs) account for 0.5-2.0 % of ruptured intracranial aneurysms. Because of their rarity, the natural history and pathophysiology of such aneurysms are not fully understood. We present two patients with BBAs treated with Bemsheets-covered clipping and discuss their pathophysiological characteristics, through the intraoperative and specific indocyanine green (ICG) video angiography (VA) findings.Case ReportA 34-year-old male and a 53-year-old female were admitted to our emergency room with suddenly reduced levels of consciousness. Brain imaging studies demonstrated a blood blister-like aneurysm of the supraclinoid segment of the right ICA. Craniotomy and an attempt of surgical clipping were performed. ICG-VA showed the filling defect of dye in aneurysm in the operative field. The BBAs were clipped after being covered by Bemsheets (Kawamoto Corporation, Osaka, Japan) and then confirmed by the ICG-VA. Postoperatively, both patients showed transient neurological deficit due to vasospasms and recovered to their normal statuses within a few months after their respective operations.ConclusionsICG-VA showed the filling defect of dye in BBAs, which supported that BBAs have been a pseudoaneurysm. In addition, although not routinely recommended in the treatment of BBAs, we believe that Bemsheet-covered clipping is a safe and effective treatment option for BBAs.

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