A case report regarding the deep hypothermia and total circulatory arrest technique for clipping giant cerebral aneurysms
Keywords:
Brain, protective agents, hypothermia, cardiopulmonary bypass, basilar artery aneurysm
Abstract
Deep hypothermia and total circulatory arrest technique for facilitating clipping complex posterior circulation cerebral aneurysms is not a new technique; however, this case report deals with the first case treated at the Hospital Santa Sofía in Manizales (Caldas) and in the Colombian coffee-growing area.
Our team reports a 53-year-old female patient who underwent surgery to clip a giant basilar artery aneurysm; closed-chest extrathoracic cannulation for femorofemoral cardiopulmonary bypass was used, involving total circulatory arrest, deep hypothermia and heparin anticoagulation. Cardiac arrest lasted 15 minutes. The patient did not require conversion to sternotomy. Blood outflow via femoral vein was sufficient to maintain cardiopulmonary bypass and induce deep hypothermia (18°C, retention of spontaneous circulation, and propofol infusion (3-5 mg · kg-1 · h-1) under general anaesthesia, thereby facilitating easy clipping. No intraoperatorive complications were presented, such as ventricular fibrillation, ventricular dilatation or haemorrhage. Haemodynamics were controlled with neosinefrin. The patient was transferred (intubated) to the ICU.
References
1. Mack WJ, Ducruet AF, Angevine PD, Komotar RJ, Shrebnick DB, Edwards NM, Smith CR, Heyer EJ, Monyero L, Connolly ES Jr, Solomon RA. Deep hypothermia and Circulatory Arrest for Surgery of Complex Intracranial Aneurysms: Lassons Learned. Neurosurgery. 2008; 62( Suppl 3):1311-23.
2. Young WL et al. Anesthetic Management of Deep Hypothermic Circulatory Arrest for Cerebral Aneurysm Clipping. Anesthesiology. 2002; 96: 497-503.
3. Massad MG et al. Closed Chest Hypothermic Circulatory Arrest for Complex Intracranial Aneurysms. Society of Thoracic Surgeons. 2001; 71: 1900-4.
4. Dewitte TC III. Endovascular Treatment of Cerebral Aneurysms Will Replace Clipping. Journal of Neurosurgical Anesthesiology. 2003; 15: 58-60.
5. Chicoine MR. Microsurgery and Clipping: The gold standard for Treatment of Intracranial Aneurysms. Journal of Neurosurgical Anesthesiology. 2003; 15: 61-3.
6. Morita KI, Inenaga C, Ito Y, Fujii Y et al. An Autopsy Case Of Gigant Aneurism of vertebrobasilar artery treated endovascular surgery. Acta Neurochirúrgica. 2003; 145: 723-5.
7. Spetzler RF et al. Giant Aneurisms. Neurosurgery. 2002; 49: 902-8.
8. Rhoton AL Jr. Aneurysms. Neurosurgery. 2002; 51: 121-58.
9. Le Roux P et al. Blood Transfusion During Aneurysm Surgery. Neurosurgery. 2001; 49: 1068-75.
10. Aebert H et al. Deep hypothermia and Circulatory Arrest for Surgery of Complex Intracranial Aneurysms. Cardio-Thoracic Surgery. 1998; 13; 223-9.
11. Hacein-Bey L, Connolly ES Jr, Mayer SA et al. Complex intracranial aneurysms: combined operative and endovascular approaches. Neurosurgery. 1998; 43:1304-12.
12. Drake CG, Barr HWK, Coles JC et al. The use of extracorporeal circulation and profound hypothermia in the treatment of ruptured intracranial aneurysm. J Neurosurg. 1964; 21:575-81.
13. Baumgartner WA, Silverberg GD, Ream AK et al. Reappraisal of cardiopulmonary bypass with deep hypothermia and circulatory arrest for complex neurosurgical operations. Surgery. 1983; 94:242-9.
14. Thomas AN, Anderton JM, Harper NJ. Anaesthesia for the treatment of a giant cerebral aneurysm under hypothermic circulatory arrest. 1990; Anaesthesia.45:383-5.
15. Spetzler RF, Hadley MN, Rigamonti D et al. Aneurysms of the basilar artery treated with circulatory arrest, hypothermia, and barbiturate cerebral protection. J Neurosurg. 1988; 68:868-79.
16. Young WL, Lawton MT, Gupta DK, et al. Anesthetic management of deep hypothermic circulatory arrest for cerebral aneurysm clipping. Anesthesiology. 2002; 96:497-503.
17. Nussmeier NA, Arlund C, Slogoff S. Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology. 1986; 64:165-70.
18. Kahveci FS, Kahveci N, Alkan T et al. Propofol versus isoflurane anesthesia under hypothermic conditions: effects on intracranial pressure and local cerebral blood flow after diffuse traumatic Brain injury in the rat. Surg Neurol. 2001; 56:206-14.
19. Hindman BJ, Todd MM, Gelb AW et al. Mild hypothermia as a protective therapy during intracranial aneurysm surgery: a randomized prospective pilot trial. Neurosurgery. 1999; 44:23-32.
20. Clifton GL. Systemic hypothermia in treatment of severe Brain injury. J Neurosurg Anesthesiol. 1995;7:152-6.
21. Johnston SC, Wilson CB, Halbach VV et al. Endovascular and surgical treatment of unruptured cerebral aneurysms: comparison of risks. Ann Neurol. 2000; 48:11-9.
22. Lai YC, Manninen PH. Anesthesia for cerebral aneurysms: a comparison between interventional neuroradiology and surgery. Can J Anaesth. 2001;48: 391-5.
2. Young WL et al. Anesthetic Management of Deep Hypothermic Circulatory Arrest for Cerebral Aneurysm Clipping. Anesthesiology. 2002; 96: 497-503.
3. Massad MG et al. Closed Chest Hypothermic Circulatory Arrest for Complex Intracranial Aneurysms. Society of Thoracic Surgeons. 2001; 71: 1900-4.
4. Dewitte TC III. Endovascular Treatment of Cerebral Aneurysms Will Replace Clipping. Journal of Neurosurgical Anesthesiology. 2003; 15: 58-60.
5. Chicoine MR. Microsurgery and Clipping: The gold standard for Treatment of Intracranial Aneurysms. Journal of Neurosurgical Anesthesiology. 2003; 15: 61-3.
6. Morita KI, Inenaga C, Ito Y, Fujii Y et al. An Autopsy Case Of Gigant Aneurism of vertebrobasilar artery treated endovascular surgery. Acta Neurochirúrgica. 2003; 145: 723-5.
7. Spetzler RF et al. Giant Aneurisms. Neurosurgery. 2002; 49: 902-8.
8. Rhoton AL Jr. Aneurysms. Neurosurgery. 2002; 51: 121-58.
9. Le Roux P et al. Blood Transfusion During Aneurysm Surgery. Neurosurgery. 2001; 49: 1068-75.
10. Aebert H et al. Deep hypothermia and Circulatory Arrest for Surgery of Complex Intracranial Aneurysms. Cardio-Thoracic Surgery. 1998; 13; 223-9.
11. Hacein-Bey L, Connolly ES Jr, Mayer SA et al. Complex intracranial aneurysms: combined operative and endovascular approaches. Neurosurgery. 1998; 43:1304-12.
12. Drake CG, Barr HWK, Coles JC et al. The use of extracorporeal circulation and profound hypothermia in the treatment of ruptured intracranial aneurysm. J Neurosurg. 1964; 21:575-81.
13. Baumgartner WA, Silverberg GD, Ream AK et al. Reappraisal of cardiopulmonary bypass with deep hypothermia and circulatory arrest for complex neurosurgical operations. Surgery. 1983; 94:242-9.
14. Thomas AN, Anderton JM, Harper NJ. Anaesthesia for the treatment of a giant cerebral aneurysm under hypothermic circulatory arrest. 1990; Anaesthesia.45:383-5.
15. Spetzler RF, Hadley MN, Rigamonti D et al. Aneurysms of the basilar artery treated with circulatory arrest, hypothermia, and barbiturate cerebral protection. J Neurosurg. 1988; 68:868-79.
16. Young WL, Lawton MT, Gupta DK, et al. Anesthetic management of deep hypothermic circulatory arrest for cerebral aneurysm clipping. Anesthesiology. 2002; 96:497-503.
17. Nussmeier NA, Arlund C, Slogoff S. Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology. 1986; 64:165-70.
18. Kahveci FS, Kahveci N, Alkan T et al. Propofol versus isoflurane anesthesia under hypothermic conditions: effects on intracranial pressure and local cerebral blood flow after diffuse traumatic Brain injury in the rat. Surg Neurol. 2001; 56:206-14.
19. Hindman BJ, Todd MM, Gelb AW et al. Mild hypothermia as a protective therapy during intracranial aneurysm surgery: a randomized prospective pilot trial. Neurosurgery. 1999; 44:23-32.
20. Clifton GL. Systemic hypothermia in treatment of severe Brain injury. J Neurosurg Anesthesiol. 1995;7:152-6.
21. Johnston SC, Wilson CB, Halbach VV et al. Endovascular and surgical treatment of unruptured cerebral aneurysms: comparison of risks. Ann Neurol. 2000; 48:11-9.
22. Lai YC, Manninen PH. Anesthesia for cerebral aneurysms: a comparison between interventional neuroradiology and surgery. Can J Anaesth. 2001;48: 391-5.
How to Cite
1.
Castro H, Jaramillo J, Pardo C, Chavez J, Isaza P, Robledo M. A case report regarding the deep hypothermia and total circulatory arrest technique for clipping giant cerebral aneurysms. Colomb. J. Anesthesiol. [Internet]. 2010 Jan. 1 [cited 2024 Jul. 22];38(1):111-23. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/314
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Published
2010-01-01
How to Cite
1.
Castro H, Jaramillo J, Pardo C, Chavez J, Isaza P, Robledo M. A case report regarding the deep hypothermia and total circulatory arrest technique for clipping giant cerebral aneurysms. Colomb. J. Anesthesiol. [Internet]. 2010 Jan. 1 [cited 2024 Jul. 22];38(1):111-23. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/314
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Case Report / Case Series
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