Introduction: A 52 year old female presented with a pulsatile mass in the right side of the neck. Patient has seizure disorder with mental retardation and wears a helmet. CT of the neck showed a 3.0 cm X 2.5 cm right internal carotid artery (ICA) aneurysm with tortuosity of the right internal carotid artery. Intraarterial digital subtraction carotid arteriography showed a 3.0 cm right ICA aneurysm with marked tortuosity of the ICA with no abnormality in the intracranial circulation.

Methods: Due to the relatively high location of the internal carotid artery aneurysm, mandibular subluxation was performed using Steinman Pins in the maxilla and mandible following nasotracheal intubation. Through a slightly oblique incision in the neck, the carotid sheath was opened. The right ICA aneurysm was exposed. The vagus and hypoglossal nerves, ICA and external carotid artery dissection was performed under the posterior belly of digastric . There was marked tortuosity of the internal carotid artery. Internal carotid artery aneurysm was resected and an end-to-end anastomosis with a 7-0 cardiovascular Prolene running suture was performed. The internal carotid artery was brought anterior to the hypoglossal nerve.

Results: Post-operative CT angiography of the neck showed satisfactory repair.

Conclusion: Satisfactory exposure of an ICA aneurysm high in the neck can be obtained by mandibular subluxation with end-to-end repair in a patient with redundant ICA.