Extracranial-intracranial bypass surgery for the repair of giant extracranial internal carotid artery aneurysms: case report of a patient presenting with dysphagia and literature review

Abstract

PURPOSE: Aneurysms of extracranial internal carotid artery (ICA) are a rare disease entity. Various open surgical repair methods and endovascular techniques have been described in the literature, however, comprehensive information is lacking. METHOD: We report a 59-year-old lady who presented with sore throat and dysphagia for few months. Physical examination showed a large pulsatile left oropharyngeal mass. Subsequent computed tomography angiography revealed a giant left cervical ICA aneurysm up to 6 cm extending to skull base. Trapping of aneurysm with extracranial-intracranial (EC-IC) bypass was performed using radial artery graft. The current literature on extracranial ICA aneurysms is also reviewed for the possible therapeutic options. RESULTS: The pulsation of the aneurysm has reduced after EC-IC bypass and trapping of the aneurysm. Post-operative CT angiogram revealed patent EC-IC graft with minimal contrast flow to left ICA aneurysm only. The patient had uneventful recovery and was discharged one week after the operation. CONCLUSION: We describe a two-team approach with vascular surgeons in the management of a giant extracranial ICA aneurysm. EC-IC bypass followed by interruption of aneurysm provides a good treatment option for large aneurysms extending to skull base. The location, size and extension of the aneurysm have to been taken into account when selecting vascular procedures for the repair of extracranial ICA aneurysms.