Yamaguchi S, Oki S, Ogasawara H, Hibino S, Sato H, Ito Y, Okazaki H
Department of Neurosurgery, Hiroshima City Asa Hospital, Japan.
No Shinkei Geka. 1997 Feb;25(2):181-5.
Extracranial internal carotid artery aneurysm is rare. Most cases are due to spontaneous or traumatic dissection of the cervical internal carotid artery. Here we report a case of surgically treated extracranial internal carotid artery (ICA) aneurysm. A 74-year-old man noticed a pulsatile mass just below the left mandibular angle. Intravenous digital subtraction angiography revealed multiple aneurysms in the systemic arteries, including the aortic arch, abdominal aorta and left extracranial ICA. It was decided to treat the aneurysms of the aortic arch and of the abdominal aorta conservatively. Cerebral angiography, however, showed a saccular aneurysm which projected latero-posteriorly at the C2 level of the left extracranial ICA. Although the patient had no previous ischemic event, we decided to treat this aneurysm surgically in view of the risk of cerebral ischemia caused by intraaneurysmal thrombus formation or rupture of the aneurysm by neck injury. The operation was performed under mild hypothermal general anesthesia. Electroencephalography was carried out during the operation. A skin incison was made from the anterior border of the sternocleidomastoid muscle to the pretragal region to expose the parotid gland. This skin incision, elevation of the parotid gland and division of the digastric muscle were useful for exposing the distal portion of the extracranial ICA. After trapping of the aneurysm, it was punctured and collapsed by aspiration and the dome was excised at its neck. The ICA was then reconstructed by suturing the cut neck of the aneurysm. Patency of the ICA was confirmed by postoperative angiography. The postoperative course was smooth except for hoarseness, which was caused by damage to a minor branch of the vagus nerve during exposure of the aneurysmal dome.
颅外颈内动脉瘤较为罕见。大多数病例是由于颈内动脉的自发性或外伤性夹层形成。在此，我们报告一例经手术治疗的颅外颈内动脉（ICA）瘤。一名74岁男性注意到左下颌角下方有一个搏动性肿块。静脉数字减影血管造影显示全身动脉多处动脉瘤，包括主动脉弓、腹主动脉和左颅外ICA。决定对主动脉弓和腹主动脉的动脉瘤进行保守治疗。然而，脑血管造影显示在左颅外ICA的C2水平有一个向外侧后方突出的囊状动脉瘤。尽管患者既往无缺血事件，但鉴于动脉瘤内血栓形成或颈部损伤导致动脉瘤破裂引起脑缺血的风险，我们决定对该动脉瘤进行手术治疗。手术在轻度低温全身麻醉下进行。术中进行了脑电图检查。沿胸锁乳突肌前缘至耳屏前区域做皮肤切口，以暴露腮腺。该皮肤切口、腮腺抬高和二腹肌分离有助于暴露颅外ICA的远端部分。动脉瘤夹闭后，穿刺抽吸使其塌陷，并在颈部切除瘤顶。然后通过缝合动脉瘤的切口颈部重建ICA。术后血管造影证实ICA通畅。术后过程顺利，除了因暴露动脉瘤瘤顶时迷走神经一个小分支受损导致声音嘶哑外。
