The use of an external-internal shunt in the treatment of extracranial internal carotid artery saccular aneurysms: Technical case report

BACKGROUND Extracranial internal carotid artery aneurysms (EICAA) are rare lesions. Re section and grafting is the preferred method of management. However, the de tails of shunt use in surgery for this type of aneurysm has been described in few articles. We describe an external-internal shunt with intra-aneurysm al trans-orifice insertion. CASE REPORT A 55-year-old woman presented with a 5-year history of a progressively enla rging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram showed a saccular EICAA involving the ICA distal t o the bifurcation, with kinking of the internal carotid artery (ICA). The d ome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm. RESULTS Using the shunt technique, we successfully removed the aneurysm and reconst ructed the ICA. The end-to-end anastomosis was easy because the shunt was i nvolved only in the distal free end of the ICA, but not in the proximal fre e end of the ICA. CONCLUSION This technique could be an option for the treatment of EICCA when a shunt i s needed to maintain the cerebral circulation. (C) 1999 by Elsevier Science Inc.