To summarize the clinical characteristics and explore the treatment strategies of blood blister-like aneurysms (BBAs), and compare the efficacy and safety of craniotomy for BBAs and endovascular treatment.

The clinical data of 68 patients with BBA admitted to the Department of Neurosurgery of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from September 2009 to August 2019 were retrospectively analyzed. Craniotomy group: 27 patients were treated with craniotomy, including clipping, wrapping and isolation. Endovascular treatment group: 41 patients were treated with endovascular treatment, using single or multiple stents, dense mesh stent assisted coil embolization and other methods. The perioperative complications and clinical prognosis of the two groups were compared. The modified Rankin scale (mRs) score was used to evaluate the prognosis at discharge.

In the craniotomy group, 22 patients were directly clipped, 4 patients were wrapped, 1 patient was isolated + bypass. There were 18 patients of intraoperative rupture hemorrhage, 21 patients of postoperative cerebral infarction, 7 patients of postoperative rebleeding, and 19 patients of postoperative hypercoagulability. At the time of discharge, the mRs score was 0-2 in 8 patients, 3-5 in 10 patients and 6 in 9 patients (death). In the endovascular treatment group, 32 patients were treated with single or multiple stent-assisted coil embolization, and 9 patients were treated with flow guiding device. There were 17 patients of intraoperative hemorrhage, 22 cases of postoperative cerebral infarction, 5 patients of postoperative rebleeding, 11 patients of decompressivecraniectomy and 26 patients of postoperative hypercoagulability. At the time of discharge, the mRs score was 0-2 in 30 patients, 3-5 in 6 patients and 6 in 5 patients (death). The follow-up time was 6-84 months. In the craniotomy group, 18 patients survived, 2 patients were lost to follow-up, and 3 patients were recurrent. In the intravascular treatment group, 34 patients survived, 3 patients were lost to follow-up, and 3 patients were recurrent.

Reconstruction and reinforcement of parent artery wall is the key to treat BBA. It is very important to monitor the coagulation function in perioperative period to deal with the high coagulation state in time, prevent cerebral vasospasm and reduce the incidence of severe cerebral infarction. Endovascular treatment appears to result in lower rates of recurrence, mortality, and better outcomes than surgical methods.