Giant intracranial aneurysms treated with deep hypothermia and circulatory arrest.
The use of deep hypothermic circulatory arrest (DHCA), using groin cannulation with the chest closed (CCDHCA), has improved the surgical treatment of large and giant cerebral aneurysms. Twelve consecutive ASA I-II patients (10 women and 2 men), with a mean age of 35 years (range 14 to 55 y) underwent DHCA for clipping or trapping of their aneurysm (giant, n=10; large, n=2; 42% posterior circulation), under balanced general anesthesia. Intraoperative standard monitors were completed with jugular oxygen saturation, pulmonary artery, pulmonary artery occlusion, central venous pressures, electroencephalography, evoked potentials, and cerebral (subdural), and core temperature. At the start of circulatory arrest, brain temperature was 15.1+/-1.1 degrees C (range 13.5 to 17.5), and core temperature 14.1+/-1.1 degrees C (range 12.7 to 17.0). Mean circulatory arrest time was 26.5+/-13.9 minutes (range 9 to 54) and anesthesia lasted 14+/-1 hours. Only one patient underwent DHCA with standard sternotomy, because of aortic insufficiency. Follow-up (up to 70 mo) revealed no deaths and Glasgow Outcome Scale at 6 months revealed good recovery in 9, moderate disability in 1, and severe disability in 2 patients. Selected patients with large/giant intracranial aneurysms, deemed unapproachable by conventional surgical techniques, were successfully treated using CCDHCA. Mortality rate was 0% and neurologic complications occurred in 25% of the patients.
Levati
Anna
A
Neurointensive Care Unit, Niguarda Hospital, Milano, Italy. lev_anna2002@yahoo.it
Tommasino
Concezione
C
Moretti
Maria Pia
MP
Paino
Roberto
R
D'Aliberti
Giuseppe
G
Santoro
Francesco
F
Meregalli
Stefania
S
Vesconi
Sergio
S
Collice
Massimo
M
D000293:Adolescent; D000328:Adult; D001831:Body Temperature; D001921:Brain / Q000502:physiology; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D003399:Craniotomy; D003422:Critical Care; D004569:Electroencephalography; D005072:Evoked Potentials, Auditory / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery* / Q000628:therapy*; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D016896:Treatment Outcome