infectious signs. Angio-âCT: ... Eugenio Rosset, Jean-âNoel Albertini, Pierre Magnan, Bertrand Ede, Jean Marc Thomassin, and Alain Branchereau. J Vasc Surg ...
Medina M*, Granell J*, Bolívar T**, Baeza C**, Polo R***, Gu8errez-‐Fonseca R* * Otolaryngology Department, Rey Juan Carlos University Hospital, Madrid, Spain ** Vascular Surgery Department, Rey Juan Carlos University Hospital, Madrid, Spain *** Otolaryngology Department, Ramón y Cajal University Hospital
INTRODUCTION Aneurisms of the extracraneal internal carotid artery (ECICA) are very uncommon. They may compromise any location in the trajectory of the carotid artery, from its bifurcation to the entrance in the skull base. Main etiological factors are dysplasia, atherosclerosis and traumatisms. They may also arise spontaneously. The most frequent presenting symptoms are neurogical deDicits, whereas bleeding or compressive symptoms secondary to giant aneurisms are very rare.
CASE REPORT 54-‐year-‐old male No medical records of interest Presenting symptom: Odynophagia, neck pain Physical examination: Left pulsatile oropharingeal mass, non inDlammatory/ infectious signs.
A
B
C
Angio-‐CT: Left parapharingeal retrostileal mass compatible with aneurism of the ICA of 49 mm of diameter. (A, B and C-‐ Axial, coronal and parasagital sections)
MANAGEMENT Resection of the aneurysm and saphenous vein by-‐pass by means of Infratemporal Fossa type A approach (IFT-‐A) TMJ
ICA ICA
ICA FNm
S
FNt
FNm
LSC
A A. B. C. D.
ICA
IdentiDication the ICA Skeletonization of the ICA Aneurism resection. FN anteriorly rerouted Saphenous vein by-‐pass
AS
B
FN
SV
FN
C
D
TMJ-‐ Temporomandibular joint, ICA-‐ Internal carotid artery, FNm-‐ Facial nerve mastoid portion, FNt-‐Facial nerve tympanic portion, LSC-‐ lateral semicircular canal, S-‐Stapes, AS-‐ Aneurismatic sac, SV-‐ Saphenous vein.
RESULTS & CONCLUSION Postoperative period uneventful. No focal neurological deDicits. Palsy of VII, IX, and X ipsilateral cranial nerves (CNs). After 4 months follow-‐up, CNs deDicits partially recovered and by-‐pass working normally. Aneurisms of the ECICA are very uncommon. Their surgical treatment is complex. They require a combined cervical and transpetrosal surgical approach. With the IFT-‐A approach described by Fisch, it is possible to expose the cervical and petrous portion of the ICA, enabling their surgical treatment with resection and primary anastomosis or by-‐pass.
Post-‐operative CT scan
BIBLIOGRAPHY Extracranial internal carotid artery aneurysm, an uncommon disease of the supra-‐aortic arteries N. Argilés Mattes, E. Hernández-‐Osma, C. Berga Fauria, V. Sanchez Salvador. Neurologia. 2012;27:53-‐5. Surgical treatment of extracranial internal carotid artery aneurysms. Eugenio Rosset, Jean-‐Noel Albertini, Pierre Magnan, Bertrand Ede, Jean Marc Thomassin, and Alain Branchereau. J Vasc Surg 2000;31:713-‐23.
