Combined microsurgical and endovascular approach in the hybrid operating angiosuite: a case series on blood-blister intracranial aneurysms.

Blood blister-like aneurysms (BBAs) are small, fragile vascular lesions that develop on the walls of the supraclinoid internal carotid artery. The absence of a defined aneurysmal neck presents challenges in both surgical and endovascular management. The hybrid operating angiosuite (HOA), which integrates microsurgical and endovascular techniques, provides a potential approach for treating these complex aneurysms. This study retrospectively evaluated a series of BBAs treated using a combination of microsurgical extracranial-intracranial (EC-IC) bypass and endovascular trapping within the HOA between 2014 and 2022. Three neurosurgical centers participated, employing a standardized protocol executed by experienced neurovascular surgeons. Seven patients (mean age: 45 years) were included in the study. Five underwent high-flow bypass, and two received superficial temporal artery double-barrel bypass. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS) at discharge and the modified Rankin Scale (mRS) at follow-up, with scores of 0-2 considered favorable. At discharge, five patients had a GOS score of 5, one had a score of 4, and one had a score of 3. In long-term follow-up (mean: 20 months), five patients improved to an mRS score of 0, one remained at 2, and one improved from an initial score of 4 to 3. Follow-up imaging at an average of 6-12 months confirmed no recurrence of BBAs and maintained bypass flow patency. While our findings suggest that a hybrid approach may be a viable treatment strategy for BBAs, further research with larger sample sizes and comparative analyses is necessary to elucidate its long-term efficacy and safety.