SURGICAL-TREATMENT OF EXTRACRANIAL CAROTID ANEURYSMS

During the past 23 years, 12 patients with aneurysm of the carotid bif urcation were treated in our department. There were 11 men and one wom an between 20 and 68 years (mean age 54.2 years). In as much as 217 pa tients were operated on for extracranial occlusive carotid disease dur ing the same period, the incidence of these aneurysms in our series ha s been estimated to be 5%. Eleven patients presented with TIAs ipsilat eral to the aneurysm. One patient presented with a painful pulsatile e nlarging mass in the neck (ruptured aneurysm) without any neurological complications. Eleven patients underwent surgical repair. Ligation of the common carotid artery was done in one patient, resection of the a neurysm with end-to-end anastomosis was performed in 2 patients, aneur ysmorraphy in 4, excision and reconstruction with reversed saphenous v ein in one, excision and reconstruction with PTFE graft in one and 2 p atients underwent endarterectomy and angioplasty of the carotid bifurc ation. One patient with a high internal carotid artery aneurysm (base of the skull) was classified as nonoperable. There were no deaths or s trokes postoperatively. Persistent cranial nerve injury was noted in 1 case (8%). Follow-up at 6 months - 10 years (mean 5.5 years) yielded and incidence of post-op TIAs of 8% attributed to intracranial occlusi ve disease. Surgical correction is the treatment of choice for extracr anial carotid aneurysm and can be performed with a very low morbidity and mortality and carries excellent long-term results.