• S Nagasawa, M Kawanishi, Y Tada, and T Ohta.
• Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
• No Shinkei Geka. 1997 Feb 1; 25 (2): 143-9.

AbstractAneurysms of the extracranial internal carotid artery are rare but may present as a mass, with ischemic symptoms, or with fatal hemorrhage. We operated on aneurysms in four patients, two males and two females, whose ages ranged from 47 to 57 years. While a lot of etiological factors for the aneurysms have been known to include trauma, vascular dysplasia, infection or surgery using patch graft for carotid endarterectomy, three aneurysms in our series were atherosclerotic and one was spontaneously dissecting. One patient had focal neurological deficit due to embolism, two presented with a growing cervical mass, and one was symptom-free. The aneurysm was located proximal below the angle of the mandible in three patients and was distal above the angle in one. All patients were found able to tolerate test occlusion of the internal carotid before surgery. The aneurysm was trapped in one case (case 1) and was encased by vascular prosthesis in another (case 4). In the other two cases, arterial reconstruction after aneurysmal resection was carried out. In one case out of the two, the aneurysm was located at the level of 2nd cervical vertebral body (case 2). Vertical mandibular osteotomy was performed posteriorly to the exit of the inferior alveolar nerve from the bone, which gave a good view of the upper third of the internal carotid artery and facilitated primary end-to-end anastomosis. In the other case in which there was a dilated distal carotid artery and multiple aneurysms at the basilar and bilateral vertebral arteries (case 3), an extracranial-intracranial (EC-IC) saphenous vein bypass was inserted so as not to increase the hemodynamic stress in the posterior circulation. Except for a transient lower cranial nerve palsy in one case (case 2), there were no incidences of morbidity or death. Magnetic resonance angiography (MRA), Doppler ultrasonography or three-dimensional CT angiography (3-D-CT-A) was found useful in evaluating the change of aneurysmal size. It is essential in surgery for an internal carotid artery aneurysm to choose an appropriate approach characterized by its size and location. It may be important in cases with associated vascular lesions to estimate the potential hemodynamic change that might be induced by aneurysmal surgery.

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