Open surgical reconstruction of the extracranial internal carotid artery aneurysm at the base of the skull: An experience of five cases in a tertiary vascular surgery center

Aim: Aneurysms of the internal carotid artery (ICA) at the base of the skull are uncommon dangerous lesions whose management remains unclear. The aim of this retrospective study is to report the short term results of open surgical repair done in our center to formulate a standardized surgical technique of ICA reconstruction with best results. Subjects and Methods: From 2017 to 2019, totally five ICA reconstructions were performed for extracranial internal carotid artery (EICA): two male patients and three female patients (mean age, 34 years). The cause was atherosclerosis (n = 3 patients), trauma (n = 1 patient), and syndromic (associated with a complex congenital cardiac condition, n = 1 patient). The symptoms were mainly swelling and pain, in one case. Results: All patients underwent open extracranial surgical reconstruction at the skull base; interposition grafting using reverse saphenous vein graft was used in three cases, after resection of the aneurysm, and direct end to end anastomosis was employed in two cases of saccular aneurysms. The ICA was patent on the postoperative angiogram in all cases. All patients are doing well on follow-up. Conclusion: Venous graft bypass and direct ICA to ICA anastomosis for EICA can be performed safely with an open surgical approach and produces durable satisfactory results.