CASE DESCRIPTION: We report the case of a 43-year-old man who underwent a diagnostic procedure and was awaiting surgery elsewhere before being transferred to our institution. A right sided blister-like aneurysm was seen on angiograms. Although the aneurysm bled intraoperatively, 2 clips were placed with one slightly catching the medial artery wall. The outcome was excellent.

CONCLUSIONS: Since blister-like aneurysms are different than saccular aneurysms both morphologically and histologically, their treatment also differs making surgical exploration and standard clipping a more hazardous situation than usual. In fact, surgical decision for blister aneurysms should be individual with alternative plans in case the initial treatment strategy fails. Such a flexible strategy also necessitates preoperative cerebrovascular flow testing and a variety of additional hardware like encircling graft clips, microsutures or wrapping material ready in the operating room on top of traditional aneurysm clips. Keywords : Blood-blister like aneurysm, Clipping, Subarachnoid hemorrhage, Treatment