Surgical treatment of extracranial internal carotid artery aneurysms

Aneurysms of the extracranial internal carotid artery (ICA) are defined as localized increases of caliber of more than 50% as compared with the reference values, which are 0.55 +/- 0.06 cm in men and 0.49 +/- 0.07 in women at the level of the ICA, and 0.99 +/- 0.10 in men and 0.92 +/- 0.10 in women at the level of the carotid bulb [I]. These lesions are rare: Schlechter found 853 cases in 820 patients in a literature review from 1687 to 1977 [2]. While atherosclerosis is the main cause of stenotic lesions of the ICA, the etiology of aneurysms is multicausal, and includes atherosclerosis, as well as dysplastic, traumatic, and infectious lesions [3]. These aneurysms are not restricted to the carotid bifurcation, which is of easy surgical approach, but may extend along the whole ACI up to where it penetrates the petrous bone. At present, neurological manifestations are the most frequent revealing sign, whereas hemorrhages or compression from giant aneurysms have nearly disappeared. The development of reconstructive surgery of ICA lesions now allows surgical treatment of all such lesions, even the most distal ones [4,5].