New exposure technique for management of giant internal carotid artery aneurysm

Abstract

We are presenting a case of giant internal carotid artery aneurysm (ICAA) managed by a new exposure technique. Following double mandibular osteotomy, the exposure of the entire aneurysm was achieved by mandible mobilization. The aneurysm repair was performed by resection and graft interposition. Mandible bone reconstruction was succeeded via mini plate osteosynthesis. No adverse events were noticed during the 24-month follow-up period. The surgical ICAA management is necessary to prevent severe complications. In cases of aneurysm extension to the skull base, double mandibular osteotomy is a safe technique that facilitates aneurysm exposure and control.

Acesso cirúrgico ao segmento cervical distal da artéria carótida interna e à bifurcação carotídea alta – revisão integrativa da literatura e proposta de protocolo

“…The majority of authors describe a vertical incision starting at the mastoid process and running parallel to the SCM muscle, 1 , 3 , 9 - 12 , 15 , 17 , 21 , 30 , 31 , 33 , 36 , 40 , 48 , 52 , 53 enabling exposure of the great auricular nerve, the mastoid process, and the retromandibular fossa. 11 Pre-auricular extensions are also described, 4 , 9 , 37 offering the advantage of facilitating identification of the facial nerve. When mandibular osteotomies (MDO) are planned, incisions can be extended along the submandibular and submental regions and the lower lip.…”

Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

“…Hemorrhage has been described as a consequence of rupture of atherosclerotic and mycotic aneurysms [7, 8]. Often patients present with no symptoms other than a palpable mass at mandibular angle [3, 9]. …”

“…Three-dimensional time-of-flight MRI angiography provides information about early stage vessel pathology and may be used for evaluation of treatment effects especially in patients with cardiovascular risk factors [11]. In patients with EICAA, further diagnostics should be performed in order to exclude concomitant cerebral and peripheral aneurysms, and chest CT angiography and Duplex Doppler Ultrasonography are recommended for this purpose [4, 9]. …”

Improved exposure for carotid endarterectomy

“…In our experience, maneuvers that include mandibular subluxation and wiring of the mandible or double mandibular osteotomy become virtually unnecessary. 4,5 Although these procedures have been largely displaced by carotid stenting, the IE retractor is still useful where an open procedure is preferable or necessary. In some patients compression by a retractor blade against the mandibular branch of the facial nerve can result in temporary neuropraxis and dysfunction.…”