Abstract
Aneurysms of the cervical internal carotid artery (ICA) are known to present with a mass, fatal hemorrhage or cerebral ischemic attack. The recent advances in skull base surgery and intravascular procedures have provided a wide variety of therapeutic options and are expected to improve results.
We report our experience in 5 patients; 2 patients presented with focal neurological deficit due to embolism, 2 with a growing cervical mass, and 1 was symptom-free. Arterial reconstruction was performed after aneurysmal resection in 2 patients. In 1 patient whose aneurysm was located high at the C2 level, vertical mandibular osteotomy was useful for resecting the aneurysm and primary end-to-end anastomosis. In the other patient who had dilated distal carotid artery and multiple vertebral and basilar aneurysms, an extracranial-intracranial saphenous vein bypass was placed to prevent potential increase of the hemodynamic stress in the posterior circulation. The most recent case with a dissecting aneurysm was treated using a stent with preservation of the ICA flow. For the other 2 patients, trapping and encasement of aneurysms were performed. In our 5 patients, three aneurysms were proved atherosclerotic and 2 were spontaneously dissecting in nature. There was neither mortality nor additional morbidity except for transient lower cranial nerve palsy in 1 case.
We found that minimally invasive diagnostic modalities such as magnetic resonance angiography, Doppler ultrasonography and 3-D-CT angiography were useful in evaluating the change of aneurysmal size. The hemodynamic effect of the intended treatment on the coexisting vascular lesions should be considered before treatment. Technique in skull base surgery is essential in the treatment of distally located aneurysms. Recent advances in intravascular procedures offer less invasive alternatives and include balloon, coiling and stent placement.
