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

Extracranial internal carotid aneurysm treated with a covered stent in an infant

BACKGROUND

Extracranial internal carotid aneurysms consist a rare pathology with an overall incidence less than 1% in the general population, and warrant treatment due to their association with cerebrovascular events and neurological complications. The incidence is even lower in the pediatric population.

CASE REPORT

A 14-month infant presented in our clinic with neck swelling of unknown origin, with subsequent MR imaging revealing an extracranial internal carotid aneurysm. Due to the patient's age and risk of surgical complications, the decision to proceed with endovascular repair with stent placement and complete exclusion of the aneurysm from the circulation was made, after multidisciplinary consultation.

RESULTS

In the pediatric population, pediatric population, endovascular stent placement can be considered at least as a last resort treatment when surgical access harbors significant risks or is impossible.

Multiple saccular aneurysms of the extracranial and intracranial internal carotid artery associated with convexobasia and arachnoid cyst in a 6-year-old boy: a case report

INTRODUCTION

We report an extremely rare case of multiple saccular aneurysms of the extracranial and intracranial internal carotid artery associated with convexobasia of the left temporal region and arachnoid cyst in a 6-year-old boy.

CASE REPORT

A 6-year-old male patient was admitted to the hospital with chief complaint of ptosis and engorgement of the left eyelid for 50 days. A 4 x 10-cm bony protuberance of the left temporal region with hemangiectasia was observed to beat with pulse without vascular murmur. computed tomographic angiography (CTA) showed two saccular aneurysms of the left internal carotid artery. The first one which was about 3 cm in length and 2 cm in maximum diameter was located in the middle of the petrous portion (including parts of C2 and C3). The second one which was about the same size was located from the middle of the cavernous portion to the upper end of the left internal carotid artery. Computed tomography showed an arachnoid cyst in the left temporal region and abnormality of the left temporal bone. According to the specific circumstances of this patient, we believe that surgical treatment is rather risky and the loss might outweigh the gain. Therefore, we suggested to the parents that the child should be followed up for the coming years for monitoring and possible treatment.

DISCUSSION

Multiple saccular aneurysms of extracranial and intracranial internal carotid artery in children are extremely rare. According to this case, the child had congenital bony protuberance of the left temporal region with hemangiectasia, which made this case particularly specific. Besides all those discovered abnormalities, this child was a healthy boy. Due to the difficulty and high risk of possible surgical treatment, we suggested that no further treatment be performed at the moment and the child should be followed up for a long period of time. Worthy examinations such as CT, CTA, and MRI are recommended for reviewing the development of aneurysms and CNS of this boy. Further treatment might be performed in the future. We welcome all forms of discussion about this case and similar cases around the globe.