SURGICAL-TREATMENT OF EXTRACRANIAL INTERNAL CAROTID-ARTERY DISSECTINGANEURYSMS

ANEURYSMS OF THE extracranial internal carotid artery (ICA) are uncomm on. A significant proportion of such aneurysms are now recognized to b e caused by arterial dissection. In some patients, surgical treatment may become necessary. The surgical treatment of 22 patients with spont aneous or traumatic dissecting aneurysms arising from the extracranial ICAs is reviewed. The mean age of the 7 women and 15 men was 39 years . The aneurysm arose from the proximal third of the extracranial ICA i n 1 patient, from the middle third in 1 patient, and from the distal t hird in 20 patients. Five patients underwent cervical carotid ligation ; in 13 patients, the aneurysms were resected, and the ICAs were recon structed, and 4 patients underwent cervical-to-intracranial ICA bypass es. There were 2 post-operative strokes (9%). Facial and lower cranial nerve palsies were commonly seen after high cervical exposure, but th ese cranial nerve palsies were transient. There were no long-term neur ological sequelae during a mean follow-up of 6.2 years. In our relativ ely limited experience, extracranial ICA dissecting aneurysms can be t reated with acceptable morbidity using a variety of techniques. Howeve r, the indications for surgical intervention in these aneurysms remain limited.