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[Extracranial aneurysms of the internal carotid artery--an otorhinolaryngologic problem?]
Insights
High cervical internal carotid aneurysms present serious risks, including bleeding and nerve paralysis. Surgical intervention is crucial for these extracranial aneurysms due to potential spontaneous rupture.
Area of Science:
- Vascular Surgery
- Neurology
- Radiology
Background:
- High cervical internal carotid aneurysms are rare but potentially life-threatening vascular conditions.
- These extracranial aneurysms can manifest with severe symptoms or remain asymptomatic until rupture.
Observation:
- Two patient cases illustrate the clinical presentation of high cervical internal carotid aneurysms.
- Symptoms included massive intermittent nasopharyngeal bleeding and sudden paralysis of cranial nerves IX-XII.
Findings:
- Extracranial internal carotid aneurysms are predominantly located at the common carotid artery bifurcation (2/3) or proximal to the skull base (1/3).
- Etiologies include congenital factors, trauma, and complications from infections like otitis media or tonsillitis.
- Arteriography is essential for accurate diagnosis.
Implications:
- A multidisciplinary surgical approach with attempted vascular reconstruction is the current therapeutic standard, even for asymptomatic aneurysms.
- Early diagnosis and surgical management are critical to prevent spontaneous, potentially fatal, rupture.
Abstract:
The problem of high cervical internal carotid aneurysms is demonstrated in two patients. One patient presented with a massive intermittent bleeding in the nasopharynx, the second with a sudden paralysis of the cranial nerves 9-12. 2/3 of these extracranial internal carotid aneurysms are situated at the bifurcation of the common carotid artery and 1/3 are located proximal the skull base. These aneurysms can be "congenital" or traumatic in origin or may arise as a complication of otitis media or tonsillitis. Diagnosis should be established by arteriography. Even for asymptomatic aneurysms the present therapeutic concept consists of a multidisciplinary surgical approach with attempted vascular reconstruction, since spontaneous rupture may occur at any moment.