Giant cervical ICA aneurysm: An unusual cauase of recureent strokes - A case series and management algorithm

Abstract

A 73-year-old male patient suffered from recurrent strokes over 2 years. An angiogram revealed a giant cervical ICA aneurysm located in the retromandibular region with a tortuous loop of redundant artery anterior to it. He was taken up for surgery where the aneurysm was resected and the free ends anastomosed under shunt cover. The patient recovered well and was discharged without deficits. Another 70-year-old lady presented with a swelling in the retro mandibular region of the neck associated with fainting episodes every time she opened her mouth wide or chewed. Angiographic studies showed a giant retro mandibular ICA aneurysm, which was treated with an EC-IC bypass with ligation of the aneurysmal sac. The patient was discharged without deficits and has hence been living normally. Cervical aneurysms are rare and challenging modality to treat for the vascular neurosurgeon. These reports highlight the variability of presentation and the choice of modalities available for treatment. Selection of the appropriate modality can be challenging. Hence, we suggest a treatment algorithm for diagnosing as well as treating the disease successfully. Keywords: Giant, Cervical aneurysm, Coiling, Surgery.