抄録
A 54-year-old house wife was admitted with a slowly enlarging pulsating mass in the right neck, which became 12×6×6 cm in size within 6 months. Neurological examination revealed a hoarseness and slightly increased deep tendon reflexes of the left upper extremity but no other abnormalities. The right pharyngeal wall was markedly swollen and pulsating. Laboratory tests were all non-contributory and carotid angiography demonstrated a large aneurysmal dilatation of the right internal carotid artery. Right cerebral circulation was diminished due to poor cross filling from the left carotid system and was partly covered by posterior circulation. Surgery was performed under moderate hypothermia and the aneurysm was totally resected using vein graft. Although the immediate postoperative course was uneventful, the patient developed massive edematous swelling of the right cerebral hemisphere at the 3rd postoperative day and succumbed to the diffuse cerebral infarction. Embolic obstruction of the middle cerebral branches was suggested from the postoperative angiography, in which the vein graft showed satisfactory patency.
Histological examination of the resected aneurysm showed advanced medial and partly intimal necrosis, although there was no ulceration of the aneurysmal wall. Only three cases of extracranial carotid aneurysm due to cystic medial necrosis were collected from the literature and surgical hazard of radical resection is discussed with a view of preventing postoperative cerebral infarction.
