Results of Surgical Management of Internal Carotid Artery Aneurysm by the Cervical Approach

doi:10.1007/s100169900079

Annals of Vascular Surgery

Volume 11, Issue 5, September 1997, Pages 482-490

https://doi.org/10.1007/s100169900079 Get rights and content

From 1981 to 1995 a total of 14 patients with a mean age of 52 years (range: 23–71) underwent surgery for 15 aneurysms of the extracranial internal carotid artery. Fusiform aneurysms of the carotid bifurcation were not included in this study. Aneurysm led to brain ischemia in 10 cases and rupture in one case. In the remaining four cases, aneurysm was asymptomatic including three that were detected following hemispheric stroke related to a contralateral aneurysm. The etiology was spontaneous dissection in four cases, blunt trauma in three cases, fibromuscular disease in five cases, and atheroma in three cases. The upper limit of the aneurysm was located at C1–C2 in six cases, at C1 in three cases, and above C1 (at the base of the skull) in six cases. The cervical approach was used to successfully perform 12 revascularizations and three ligations (including one after extra-intracranial bypass). There were no postoperative deaths. One transient ischemic attack (TIA) occurred after ligation. Peripheral facial paralysis (PFP) occurred in four of the nine cases in which an extended cervical approach was used. No patients were lost to follow-up. Mean duration of follow-up was 4 years (range: 2 months-10 years). Two patients died at 2 and 4 years of causes unrelated to the procedure. All carotid reconstructions are currently patent and no neurologic manifestations have occurred. PFP persisted in one case. The results of this series confirm that surgical therapy of aneurysms of the extracranial internal carotid artery achieves satisfactory short- and medium-term results and that the extended cervical approach allows treatment of lesions near the base of the skull.

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Haemophilus parainfluenzae from a dental abscess is a potential cause of mycotic ICA aneurysm. ICA aneurysms at the C1/C2 level may require an extended cervical approach, including some or all of the following maneuvers: fracture/resection of styloid process as well as muscles and ligaments inserted into the styloid process, dissection of the last four cranial nerves, and, rarely, sternocleidomastoid muscle detachment from the tip of the mastoid.14 Evaluating for endocarditis by echocardiography is standard of care in patients with endovascular infections (ie, mycotic aneurysms); however, this case demonstrates direct bacterial invasion from a dental abscess to the ICA as mechanism for rapid development of a mycotic aneurysm.
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Rupture of an extracranial carotid artery aneurysm (ECAA) is a very rare and life-threatening condition. To obtain a comprehensive view of previous and current management of ruptured ECAAs (rECAAs), we analyzed all cases reported since 1940 and two of our own cases.
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Les traumatismes cervico-faciaux par corps étrangers transfixiants sont rares et associés à un risque important de lésions vasculo-nerveuses. Ils nécessitent une prise en charge chirurgicale pluridisciplinaire.
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This potentially fatal bleeding risk constitutes a major argument in favour of rapid surgical management. In the event of an arterial injury caused by removal of the foreign body, the interventional radiologists would have performed internal carotid artery embolization, although this procedure is rarely performed and is associated with high morbidity and mortality (66 to 100% of cases) [1,2]. This high-risk procedure is therefore reserved for cases of massive bleeding that cannot be treated surgically.
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Aneurysms of the extracranial carotid artery (ECAA) are rare. Several treatments have been developed over the last 20 years, yet the preferred method to treat ECAA remains unknown. This paper is a review of all available literature on the risk of complications and long-term outcome after conservative or invasive treatment of patients with ECAA.
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View all citing articles on Scopus

: Presented at the Annual Meeting of the Societé de Chirurgie Vasculaire de Langue Française, Bruges, Belgium, June 1–3, 1995.

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Results of Surgical Management of Internal Carotid Artery Aneurysm by the Cervical Approach

Eur J Vasc Surg

Ann Vasc Surg

Am J Surg

Ann Vasc Surg

J Vasc Surg

J Vasc Surg

J Vasc Surg

Extracraniai aneurysm of the internal carotid artery: History and analysis of the cases registered up to August 1. 1925

Arch Surg

Carotid artery aneurysms: Review of the literature and report of a case with rupture into the oropharynx

Arch Surg

Chirurgie de l'artère carotide interne juxtacranienne

Anévrismes disséquants chroniques de la carotide interne: Place du traitement chirurgical

Surgical management of aneurysms of the distal extractranial internal carotid artery

J Neurosurg

Surgical therapy of internal carotid artery lesions of the skull base and temporal bone

Otolaryngol Head Neck Surg

Facial nerve grading system

Otolaryngol Head Neck Surg

Cervical carotid ancurysms

New York State J Med

Aneurysms of the extracranial carotid artery

Surgery

Extra-cranial carotid artery aneurysms

Surgery

False aneurysm after carotid endarterectomy

Arch Surg

Chirugie des lésions non athéromateuses carotidiennes

Aneurysms of extracranial carotid arteries

Arch Surg