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Table 1 Review of reported intraoperative aneurysm microsuture cases

From: Intraoperative rupture of blood blister-like aneurysm: a case report and review of literature

Reference number Age/sex SAH grade Location Surgical strategy Stenosis of artery Patency confirmation Outcomes
Vashu et al. [24] 14/F WFNS Grade II Right supraclinoid ICA aneurysm 8/0 Prolene 4 stitches—20-min clipping + barbiturate No CTA No neurological deficit—no recurrence at 11 months follow-up
Vashu et al. [24] 48/F WFNS Grade I Right supraclinoid ICA aneurysm 7/0 Prolene 4 stitches—23-min clipping + another 28-min clipping + barbiturate No DSA GOS-5 at 5 months follow-up, left side limb weakness 4/5
Yanaka et al. [25] 46/F H&H III Right supraclinoid ICA aneurysm 8/0 nylon 2 stitches—Surgicel + fibrin glue + encircling clip Spasm DSA Returned to normal activities at 3 months follow-up
Lee et al. [7] 46/F H&H II Left dorsolateral ICA Suture—temporary clip time 36 min NM NM Global infarction—death
Otani et al. [17] 40/F H&H V Right ICA Clip on wrapping with suture Spasm NM Moderate disability
Park [26] 58/F   Right superior to medial wall ICA aneurysm 8/0 polypropylene No DSA mRs 3 at 3 months follow-up
Joo et al. [23] 30/M H&H III Left ICA Suture tear with 8/0 nylon + wrapping + clipping—20 min ICA occluded DSA Discrete hemiparesis (4/5)
Joo et al. [23] 33/M FISHER III Right supraclinoid ICA aneurysm Suture with 8/0 nylon + wrapping + clipping NO DSA Good
Our case 68/M H&H II Right supraclinoid ICA aneurysm 8/0 Prolene 3 sutures—22-min clipping NM NM mRS 3 at 8 months follow-up
  1. As we can see from Table 1, male to female ratio is 2:1, age distribution of 14–68 years old (mean age of 43 years old). Seven out of these 9 cases (77.8 %) were from the right side, and right supraclinoid ICA aneurysms seem to be more common. 8/0 Prolene sutures were preferred for suturing, and average time of temporary clipping of ICA was 26 min. All the BBLA in this review was intraoperatively ruptured and then sutured. No reports of rebleeding or recurrence were noted, and the postoperative outcomes were good except in one case where the patient died
  2. M male, F female, WFNS World Federation of Neurosurgeons Subarachnoid Hemorrhage (SAH) Grading System, H&H Hunt and Hess SAH Scale, FISHER Fisher SAH Grade, GOS Glasgow Outcome Scale, mRs modified Rankin scale, NM not mentioned, CTA computed tomography angiography, DSA digital subtraction angiography