RESULTS OF SURGICAL-MANAGEMENT OF INTERNAL CAROTID-ARTERY ANEURYSM BYTHE CERVICAL APPROACH

From 1981 to 1995 a total of 14 patients with a mean age of 52 years ( range: 23-71) underwent surgery for 15 aneurysms of the extracranial i nternal carotid artery. Fuslform aneurysms of the carotid bifurcation were not included in this study. Aneurysm led to brain ischemia in 10 cases and rupture in one case. In the remaining four cases, aneurysm w as asymptomatic including three that were detected following hemispher ic stroke related to a contralateral aneurysm. The etiology was sponta neous dissection in four cases, blunt trauma in three cases, fibromusc ular disease in live cases, and atheroma in three cases, The upper lim it of the aneurysm was located at C1-C2 in six cases, at C1 in three c ases, and above C1 (at the base of the skull) in six cases. The cervic al approach was used to successfully perform 12 revascularizations and three ligations (including one after extra-intracranial bypass). Ther e were no postoperative deaths. One transient ischemic attack (TIA) oc curred after ligation. Peripheral facial paralysis (PFP) occurred in f our of the nine cases in which an extended cervical approach was used. Na patients were lost to follow-up. Mean duration of follow-up was 4 years (range: 2 months-10 years). Two patients died at 2 and 4 years o f causes unrelated to the procedure. All carotid reconstructions are c urrently patent and no neurologic manifestations have occurred. PFP pe rsisted in one case. The results of this series confirm that surgical therapy of aneurysms of the extracranial internal carotid artery achie ves satisfactory short-and medium-term results and that the extended c ervical approach allows treatment of lesions near the base of the skul l.