Between 1988 and 2005, 13 patients (11 men; age 18 to 76 years, mean 42.6 years) underwent lateral skull base approach with cervical-to-petrous carotid artery bypass for repair of ICA
aneurysms. Principal elements of the technique were: partial resection of the parotid gland without rerouting of the facial nerve; luxation of mandibula; drilling of the bone.
RESULTS: The 13 patients had unilateral
aneurysm of the ICA at the base of the skull. Four
aneurysms were of atherosclerotic origin; six
fibromuscular dysplasia; two post-traumatic; one cause was undetermined. The mean diameter of the
aneurysms was 12 mm (range, 7-21 mm). Twelve patients were symptomatic: six presented neurological events (four
strokes, two
transient ischemic attack [TIA]); two
retinal events; three compressive symptoms (two
Horner's syndrome and one
paralysis of the glossopharyngeal nerve); one patient presented a visible pulsatile mass in the neck. One patient was asymptomatic. There were no post-operative deaths, one TIA, 13 transient
palsies of the lower facial nerve, and one transient
palsy of accessory nerve.
Palsy of cranial nerves was partial and disappeared within a mean of 5.6 months (range, 1-10 months). The postoperative angiogram showed patency in all but one case (one asymptomatic
thrombosis). During follow-up (mean, 152 months), there was one unrelated death, one focal epileptic seizure, and one controlateral TIA. In November 2008, duplex showed patency of all 11 grafts (one death, one
thrombosis).
At 10 years, the survival, cumulative
stroke-free survival, ipsilateral
stroke-free, and patency rates was were 90.9%, 100%, 100%, and 92.3%.
CONCLUSION: Venous graft bypass from the cervical-to-petrous ICA can be performed safely with such an approach and produces durable satisfactory results.