Elsevier

Surgical Neurology

Volume 52, Issue 2, August 1999, Pages 153-155
Surgical Neurology

Technical Note
The use of an external-internal shunt in the treatment of extracranial internal carotid artery saccular aneurysms: technical case report

https://doi.org/10.1016/S0090-3019(99)00039-7Get rights and content

Abstract

BACKGROUND

Extracranial internal carotid artery aneurysms (EICAA) are rare lesions. Resection and grafting is the preferred method of management. However, the details of shunt use in surgery for this type of aneurysm has been described in few articles. We describe an external-internal shunt with intra-aneurysmal trans-orifice insertion.

CASE REPORT

A 55-year-old woman presented with a 5-year history of a progressively enlarging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram showed a saccular EICAA involving the ICA distal to the bifurcation, with kinking of the internal carotid artery (ICA). The dome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm.

RESULTS

Using the shunt technique, we successfully removed the aneurysm and reconstructed the ICA. The end-to-end anastomosis was easy because the shunt was involved only in the distal free end of the ICA, but not in the proximal free end of the ICA.

CONCLUSION

This technique could be an option for the treatment of EICCA when a shunt is needed to maintain the cerebral circulation.

Section snippets

An illustrative case

A 55-year-old woman presented with a 5-year history of a progressively enlarging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram (CAG) showed a saccular EICAA involving the internal carotid artery (ICA) distal to the bifurcation, with kinking of the ICA (Figure 1A). The dome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm (Figure 1A). Preoperative ICA balloon occlusion test showed a stump

Technique

At surgery, the standard carotid approach anterior to the sternomastoid muscle was used. It was difficult to control the distal ICA because of the large aneurysmal sac. After an intravenous bolus of 3000 units of heparin, vessel tapes were placed around the ICA, external carotid artery (ECA) and common carotid artery (CCA). First, all three vessels were occluded with bulldog clamps. During the occlusion the aneurysmal sac was partially incised and opened. There was no intra-aneurysmal thrombus.

Discussion

The incidence of EICAA has been reported to be less than 2% of all carotid operations 3, 6. Saccular aneurysms constitute 22–38% of EICCA 3, 6, 8. Most authors support surgical treatment for EICAA because of the high rate of neurological symptoms (38–92%) 2, 3, 5, 6. Nonoperative treatment is associated with an unacceptable stroke rate (50%) [9]. Even for asymptomatic aneurysms, operative therapy seems to be justified to prevent neurological symptoms in the future [2].

For saccular EICAA the

References (9)

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