A 37-year old man was admitted due to the left subauricular mass of 6 month duration which was 3 x 4cm sized, pulsatile and slowly growing. He was suffered from the intermittent left facial and auricular pain radiating to tbe´occipital area. The carotid angiograpl´ y revealed 3 x 4cm sized saccular aneurysm of the left internal carotid artery just above the carotid bifurcation, extending to the mandibular angle level.
He was planned to be operated under the direct clamp of internal larotid artery or shunting procedure. But, the back pressure of the internal carotid was 35mmHg, which suggested adequate cerebral collateral.
Thereby, aneurysmectomy and restoration of cerebral blood flow with saphenous vein graft was done under the direct clamp of internal carotid artery for 25 minutes.
Although mild transient neurologic sequelae such as mydriasis, tongue deviation for 10 days, he recovered completely without any complication. The aneurysmal sac had no thrombus and pathologic finding was compatible with congenital origin.
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