Bypass Surgery to Treat Symptomatic Fusiform Dilation of the Internal Carotid Artery following Craniopharyngioma Resection

Fusiform dilation of the internal carotid artery is an infrequent vascular complication following craniopharyngioma resection in the pediatric population, and its property appears to be benign without apparent clinical symptoms. However, data correlating symptomatic fusiform dilation of the internal carotid artery with bypass surgery are scarce. The authors report two symptomatic cases that were treated by internal maxillary artery bypass more than 5 years after total removal of a craniopharyngioma at an outside institution. Both cases of fusiform dilation of the internal carotid artery were resected to release the mass effect and to expose the craniopharyngioma. The postoperative course was uneventful, and radiologic imaging revealed graft conduit patency. This is, to our knowledge, the first report on the using of extracranial-to-intracranial bypass to treat fusiform dilation of the internal carotid artery following removal of a suprasellar lesion. This finding suggests that bypass surgery is a useful therapeutic approach for symptomatic cases of fusiform dilation of the internal carotid artery and total removal of recurrent craniopharyngioma. Moreover, the indications for surgical intervention and treatment modalities are discussed in the context of previous relevant cases.