Surgical treatment of giant fusiform aneurysm of extracranial internal carotid artery in a child: 1 case report and literature review

Abstract

Background The objective of this study is to report diagnosis and treatment results of giant fusiform aneurysm of extracranial internal carotid artery in a child and review the relative reference to enhance the knowledge of it. Methods A 13-year-old female patient was admitted to the hospital with chief complaint of pulsatile mass in her left cervical area for 1 year, which had abruptly augmented 2 months earlier. No cervical trauma or infection appeared. A 3.5 × 6–cm mass in the left cervical angle of the mandible was observed to beat with pulse without vascular murmur. Digital subtraction angiography and CTA showed a giant fusiform aneurysm 6 cm in length and 3 cm in maximum diameter from the beginning of the left internal carotid artery. After resection of the aneurysm, vascular continuity was restored by interposition of a 6-mm PTFE graft. Results Pathologic examinations showed hyperplasia in artery wall, fibroplasias and mucous degeneration, hyalinization, chronic inflammatory cell infiltration, and local calcification. The recovery was good without complication. The patient was followed up in 2 years postoperation. The CTA and color Doppler ultrasonography showed good configuration and distribution of the internal carotid artery and good circulation in vascular cavity. Conclusions Giant fusiform aneurysm of extracranial internal carotid artery in children is rather rare. The main causes are atherosclerosis, infection and trauma, incurring by carotid endarterectomy, and the like. Most of the clinical manifestations are pulsatile nontender mass. It can cause severe complications, such as brain ischemia or cervical hematorrhea incurred by rupture of aneurysm. The therapy includes resection of the aneurysm and restoration of flow with venous, arterial, or prosthetic graft or endovascular stenting.