Surgical management of extracranial internal carotid aneurysms

INTRODUCTION: Extracranial internal carotid artery (EICA) aneurysms are rare and their causes are variable. Our main goal was to evaluate the results of the surgical treatment of the EICA aneurysms. PATIENTS AND METHOD: Between January 1993 and January 2008, 1028 carotid surgeries were performed by the senior author. Of these, 11 patients (1,07%), been nine men (mean age, 61,89 +/- 8,58 years) were submitted to surgical treatment of the EICA aneurysms. The causes were: atherosclerosis (n=8); fibromuscular dysplasia (n=2); and dissection (n=1). Eight patients (72 %) were symptomatic before the surgery, and the symptoms were transient ischemic attack (n=3); painful pulsatile mass in neck (n=3); and amaurosis fugax (n=2(. Demographic and surgical data and long term results were evaluated. RESULTS: There were no deaths, none neurologic complications (stroke and transient ischemic attacks) after the surgery. Furthermore, there were two transient cranial nerve dysfunction (18,2%) in the perioperative period. The median follow up time was 36 months (1 a 180 meses). During the follow up, one patient died after a trauma by gunshot after 36 months of the carotid surgery. There was a reoperation in a female patient with fibromuscular dysplasia that presented a critical stenosis in the distal anastomosis of her first operation (18 months before(. After surgery, she developed a transient dysfagia that resolved in four weeks. In the remain patients that were submitted to carotid revascularization, there was no vascular problem (stenosis, occlusion, pseudoaneurysm) diagnosed by duplex ultrasonography during the follow up. CONCLUSION: Surgical treatment of the EICA aneurysms can be performed with very good short and long term results with very low neurologic complications and mortality. The follow up of the operated patients is very important and permit to identify vascular problems which can be corrected, when necessary.