Giant petrous carotid aneurysm treated by submandibular carotid-saphenous vein bypass. Case report

Petrous and cavernous sinus carotid artery (CA) aneurysms that are not amenable to clip ligation or endovascular therapy may be successfully treated by a saphenous vein bypass, thereby preserving the patency of the CA. The authors report the unique case of a 47-year-old man with a giant fusiform aneurysm of the petrous CA, who presented with a rapid onset of a lateral rectus palsy and diplopia. The lesion was treated by trapping the aneurysm and performing a saphenous vein bypass from the cervical to the intracranial CA. The saphenous vein graft was routed beneath the condyle of the mandible to reduce the overall length of the graft, thereby increasing the likelihood of long-term patency and offering protection to the graft by the mandible, temporal muscle zygomatic process, and masseter and temporal muscles. The presentation and technical aspects of the bypass graft in this unique case are discussed.