Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report.
Large cerebral aneurysms of the basilar apex are difficult to treat. Recently, endovascular treatment has mitigated much of the morbidity associated with treating these lesions. However, the morphology of aneurysms of the vertebrobasilar system can preclude endovascular treatment. Rapid ventricular pacing (RVP) facilitates open surgical treatment of cerebral aneurysms. It can assist in reducing the pressure of the neck of the aneurysm, allowing safe application of a clip. The authors present a case of a pediatric patient who developed a basilar artery pseudoaneurysm that required surgery. Given the large size of the aneurysm, RVP was performed, allowing the surgeons to dissect the dome of the aneurysm from the surrounding tissue and pontine perforating branches away from the lesion to safely clip the lesion. The patient had an uneventful recovery. To the authors' knowledge, this represents the first known case of RVP to aid in basilar artery clip occlusion in a pediatric patient.
Departments of 1 Radiology and.|Divisions of 2 Neurosurgery and.
Shahid M
SM
Nimjee
Departments of 1 Radiology and.
Tony P
TP
Smith
4Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina.
Ronald J
RJ
Kanter
3Anesthesiology, and.
Warwick
W
Ames
3Anesthesiology, and.
Kelly A
KA
Machovec
Divisions of 2 Neurosurgery and.
Gerald A
GA
Grant
Divisions of 2 Neurosurgery and.
Ali R
AR
Zomorodi
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D002675:Child, Preschool; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
MABP = mean arterial blood pressure; PCA = posterior cerebral artery; RVP = rapid ventricular pacing; SCA = superior cerebellar artery; basilar artery aneurysm; pediatric; rapid ventricular pacing; trauma; vascular disorders