title: The use of an external-internal shunt in the treatment of extracranial internal carotid artery saccular aneurysms: technical case report.
abstract: BACKGROUND
  Extracranial internal carotid artery aneurysms (EICAA) are rare lesions. Resection and grafting is the preferred method of management. However, the details of shunt use in surgery for this type of aneurysm has been described in few articles. We describe an external-internal shunt with intra-aneurysmal trans-orifice insertion.
  
  
  METHODS
  A 55-year-old woman presented with a 5-year history of a progressively enlarging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram showed a saccular EICAA involving the ICA distal to the bifurcation, with kinking of the internal carotid artery (ICA). The dome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm.
  
  
  RESULTS
  Using the shunt technique, we successfully removed the aneurysm and reconstructed the ICA. The end-to-end anastomosis was easy because the shunt was involved only in the distal free end of the ICA, but not in the proximal free end of the ICA.
  
  
  CONCLUSIONS
  This technique could be an option for the treatment of EICCA when a shunt is needed to maintain the cerebral circulation.
authors.affiliation: Department of Neurosurgery, Hyogo Brain and Heart Center, Himeji, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hosoda
authors.forename: S
authors.initials: S
authors.lastname: Fujita
authors.forename: T
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Shibata
authors.forename: N
authors.initials: N
authors.lastname: Tamaki
mesh_terms: D000714:Anastomosis, Surgical; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002342:Carotid Artery, External / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D014656:Vascular Surgical Procedures / Q000379:methods*