title: Management of a giant intracranial aneurysm using surface-heparinized extracorporeal circulation and controlled deep hypothermic low flow perfusion. A case report.
abstract: Extracorporeal circulation with controlled hypothermic low flow perfusion was introduced during the surgical treatment of a patient with a giant intracranial aneurysm of the anterior communicating artery. Heparin-coated equipment (Carmeda Bio-Active Surface; CBAS) was utilized, thus reducing the need for systemic heparinization. Direct cannulation of the right atrium and aorta was established through thoracotomy. Blood flow through the circuit was kept at 4.5 l/min during normothermia. Core cooling, in combination with external surface cooling, was performed for 30 min to a temperature of 18 degrees C (nasopharynx). During a period of 25 min, the time for surgical repair of the aneurysm, blood flow was minimized to 0.4 l.min-1, equilibrating central and peripheral blood pressures to approximately 5-10 mmHg (0.65-1.3 kPa). Reperfusion was started immediately after the low flow period concomitantly with rewarming, aiming at a temperature of 36 degrees C following 150 min. The patient could be weaned off the extracorporeal circulation with minimal inotropic support. The postoperative course was uneventful apart from a left-sided hemiparesis, probably due to an infarction in the area of the right pericallosal artery (A2). The patient was weaned off the ventilator after 6 days. He recovered and the hemiparesis regressed slowly.
authors.affiliation: Department of Anaesthesiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Jolin
authors.forename: E
authors.initials: E
authors.lastname: Edén
authors.forename: H
authors.initials: H
authors.lastname: Berggren
authors.forename: A
authors.initials: A
authors.lastname: Roos
authors.forename: C
authors.initials: C
authors.lastname: von Essen
authors.forename: H
authors.initials: H
authors.lastname: Stephensen
authors.forename: A
authors.initials: A
authors.lastname: Hedström
authors.forename: H
authors.initials: H
authors.lastname: Karlsson
authors.forename: L
authors.initials: L
authors.lastname: Lindholm-Fransson
authors.forename: S E
authors.initials: SE
authors.lastname: Ricksten
mesh_terms: D000368:Aged; D005112:Extracorporeal Circulation; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007036:Hypothermia, Induced; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D010477:Perfusion / Q000379:methods; D013499:Surface Properties
chemical_list: D006493:Heparin