PMC6804523_01
Right anterior neck swelling.
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A 65 year old woman with Marfan syndrome presented to the otolaryngology service with asymptomatic swelling in the right anterior triangle of the neck (Fig. 1).
Pre-operative computed tomography angiography.
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CT angiography revealed bilateral extracranial fusiform ICA aneurysms (Fig. 2), with significant tortuosity and thrombus.
Hypoglossal nerve overlying the right internal carotid artery aneurysm.
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The hypoglossal nerve was clearly visualised draped over the aneurysm sac (Fig. 3) and was mobilised to permit access for clamp placement (Fig. 4).
Right internal carotid artery after aneurysm excision and end to end anastomosis.
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The aneurysm sac was excised and the ICA tortuosity permitted an end to end reconstruction (Fig. 5). The patient made an uneventful recovery and was discharged on post-operative day two.
Left internal carotid artery aneurysm managed by great saphenous vein interposition graft.
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The aneurysm sac was excised and an autologous great saphenous vein interposition graft was used to reconstruct the artery (Fig. 6).