Internal carotid artery aneurysm repair requiring skull base resection: a case study

A 51-year-old man with a history of hypertension and smoking with an internal carotid artery (ICA) aneurysm was a referral from an outside hospital. He had a history remarkable for headaches for 6 months refractory to conventional therapy, but no stroke, transient ischemic attack, seizure activity, or neck pain. Arteriogram revealed a right ICA aneurysm at the level of the skull base with no accessible cervical ICA distal to the aneurysm. The petrous and intracranial ICA were normal. A team approach to repair was undertaken with a skull base resection and ICA exposure by head and neck surgeons and vascular reconstruction with vein graft from common carotid to petrous portion of ICA by vascular surgeons. A small right parietal infarction was noted in the postoperative period and became a focus of seizure activity. Anti-seizure medication was successful and transient upper-extremity weakness cleared. Transient dysfunction of cranial nerves VII and IX developed. The complex nature of the operation required expertise from different surgical specialties, and the postoperative complication mandated medical specialty and extensive inpatient and outpatient physical, occupational, and speech therapies ICA aneurysms of the skull base are uncommon. Historic treatment involved either ligation with a high risk of stroke or bypass to intracranial artery because direct repair was difficult. With a skilled team approach, direct repair as described is effective. This article focuses on the complexity of the surgical procedure, perioperative care, outcome of surgical intervention, and a multidisciplinary approach to the care of the patient undergoing ICA aneurysm repair requiring skull base resection.