Management of a nontraumatic extracranial internal carotid aneurysm with external carotid transposition

Primary aneurysms of the extracranial internal carotid artery are exceptionally rare, with only a very few reports in the medical literature that are not related to known connective tissue disease or antecedent trauma. The natural history of these entities has not been precisely defined. Nevertheless, the embolic risk that an aneurysm at this location represents mandates prompt intervention when identified. We present the case of a 42-year-old female who was found to have a 3-cm aneurysm of the right extracranial internal carotid artery after seeing a physician for refractory headaches. In an austere environment with limited resources, this patient was successfully managed with the use of external carotid transposition to the distal internal carotid artery, cephalad to the aneurysm.