Open Repair of Two Ipsilateral Extracranial Internal Carotid Artery Aneurysms

A patient with two ipsilateral extracranial internal carotid artery (ICA) aneurysms treated by open repair is reported, with an emphasis on pre-operative planning and decision making, and a review of literature.

A 44 year old man was diagnosed with a right thyroid lobe nodule and two asymptomatic ipsilateral aneurysms of the right ICA. Diagnostic workup using three dimensional reconstruction and centre lumen line measurements on computed tomography revealed two aneurysms of the right ICA, both > 20 mm. Surgery was planned with intra-operative mandibular subluxation to maximise distal exposure. Neuromonitoring consisted of transcranial Doppler ultrasound and electroencephalography. After mandibular subluxation and complete dissection of the aneurysms and digastric muscle division, adequate exposure of the distal ICA was obtained, followed by resection of both aneurysms, and reconstruction with a reversed greater saphenous vein graft. No complications occurred and one year follow up showed a patent graft without signs of stenosis or anastomotic aneurysm.

Open repair of two ipsilateral extracranial ICA aneurysms can be performed safely after careful pre-operative planning using visualisation of the vascular anatomy and distance measurements, and maximising exposure with digastric muscle division, styloidectomy, if necessary, and mandibular subluxation.