PMC10316225_01
Preoperative vessel imaging. Magnetic resonance image showing a vascular lesion in the left neck with a diameter of 25 mm (a). Digital subtraction angiograms in the early (b) and late (c) phases showing a giant saccular aneurysm of the cervical internal carotid artery (ICA) with the disturbance of blood flow. 3D-rotational angiogram showing the elongation and tortuosity of the vessel (d and e); the dotted line represents the Blaisdel line. The length of the distal ICA was 35 mm (double arrow). No hypoperfusion was observed on single-photon emission computed tomography images (f); the color bar represents the cerebral blood flow (mL/min/100g) of each individual voxel.
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F1
Magnetic resonance imaging performed on admission revealed a vascular lesion measuring 25 mm in diameter [Figure 1a]. Digital subtraction angiography performed after admission revealed a giant saccular ICA aneurysm with flow disturbance, elongation, and tortuosity [Figures 1b-e]. Single-photon emission computed tomography (CT) showed no hypoperfusion [Figure 1f].
Intraoperative images and schemes. Exposure of the aneurysm was performed through the standard approach along the anterior line of the sternocleidomastoid muscle (a), and aneurysmectomy and side-to-end anastomosis of the internal carotid artery were performed (b). CCA: Common carotid artery, ECA: External carotid artery, ICA: Internal carotid artery, LA: lingual artery, SThA: Superior thyroid artery.
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F2
Under general anesthesia and motor-evoked potential (MEP), the aneurysm was excised, and side-to-end anastomosis of the cervical ICA was performed [Figure 2]. The aneurysm was exposed using a standard approach along the anterior border of the sternocleidomastoid muscle (SCM), dissecting from the parotid gland (PG) for a high-cervical approach [Figure 2a]. The excess length of the ICA allowed aneurysmectomy with side-to-end anastomosis using the Gore-Tex suture [Figure 2b].
Histopathological images showing the atherosclerotic aneurysm. The aneurysmal wall shows atheromatous changes with clusters of foamy cells and high cholesterol deposition (a). Elastica van Gieson staining showing the disappearance of elastic fibers in the internal elastic lamina and media (b). Postoperative computed tomography angiograph showing complete aneurysm removal and patency of the internal carotid artery (c).
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F3
Histopathological examination revealed an atherosclerotic aneurysm without dysplasia [Figure 3a]. Elastica van Gieson staining revealed the disappearance of elastic fibers in the internal elastic lamina and media [Figure 3b]. CT angiography on postoperative day 1 showed complete removal of the aneurysm and a patent cervical ICA anastomosis [Figure 3c].