Open surgical reconstruction of the internal carotid artery aneurysm at the base of the skull

Drawing of the exposure of the ICA in the infra-temporal fossa after luxation of the mandibula. Insert: skin incision. ICA, internal carotid artery.

PerI-operative view. Insert: specific retractor. Arrow: ICA. The loop is at the level of the opening of the petrous canal. Double arrow: Facial nerve. ICA, internal carotid artery.

Division of the ICA in three segments: Segment 1, the bicarotid region. Segment 2, the retrostyloid region. Segment 3, the infratemporal fossa below the penetration into the base of the skull. The oblique line corresponds to the classic Blaisdell line¹¹ between the tip of the mastoid process and the angle of the jaw. ICA, internal carotid artery.

CT scan: with maximum intensity projection (left) and 3D reconstruction (right) of a fibromuscular dysplasic voluminous aneurysm at the contact of the base of the skull. This type of imaging allows to determine precisely the relationship between the aneurysm and the osseous elements. CT, Computed tomography.

Picture of one of the patients of this series at the fifth post-operative day. Note the discrete palsy of the lower facial nerve without trouble on the higher territory.

Postoperative CT-angiogram of a venous graft. The arrow on the right corresponds to the resection of the mastoid and the vaginal processes. CT, Computed tomography.