Case Report
Giant saccular aneurysm of the internal carotid artery with adhesion to the vagus nerve: A Case Report

https://doi.org/10.1016/j.ijscr.2021.105845Get rights and content
Under a Creative Commons license
open access

Highlights

  • Aneurysm of the extracranial carotid artery with the adhesion to the vagus nerve is an extremely rare situation.

  • Open surgery must be considered in the case of the immense size of the aneurysm and the tortuous anatomical path.

  • Leaving parts of the aneurysmal wall may be necessary to avoid a permanent nerve injury.

Abstract

Introduction and importance

Aneurysms of the carotid artery are rare and potentially a risk factor for developing neurological events. This case report describes the treatment of a giant saccular aneurysm of the right extracranial internal carotid artery (ICA) with adhesion to the vagus verve.

Case presentation

An 85-year-old female presented with an asymptomatic pulsating mass on the right neck. Ultrasonography and MR angiography revealed a giant aneurysm of the right internal carotid artery with a massive tortuosity. Intraoperatively, a massive adhesion of the vagus nerve to the aneurysm was found. A resection of the aneurysm followed by a spatulated end-to-end anastomosis was performed. Postprocedural neurological symptoms included a transient paralysis of the vagus nerve that recovered within six weeks.

Clinical discussion

The treatment options of ICA aneurysms include open surgical and endovascular interventions. Endovascular treatment may be a good option for aneurysms with a particular morphology. However, open surgery is the favorable option for immense ICA aneurysms with a tortuous anatomical path.

Conclusion

Aneurysm resection with end-to-end anastomosis is a possible surgical option in the case of tortuous extracranial ICA aneurysms. Leaving parts of the aneurysmal wall prevented occurring persisting damage of the adhesive vagus nerve.

Keywords

Case report
Internal carotid artery aneurysm
Paralysis of the vagus nerve
Dysphagia
Dysphonia

Cited by (0)