Deep Hypothermia and Surgical Treatment of Intracranial Aneurysms

Uihlein, Alfred

doi:10.1001/jama.1966.03100080079020

Cited by 37 publications

(8 citation statements)

References 8 publications

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“…While surgical ex posure was excellent, postoperative bleeding during rewarming and neurologic deficits led him to aban don the technique. Uihlein et al (1966) reported 67 patients with aneurysms similarly treated at the Mayo Clinic from 1960 to 1965. These surgeons de scribed excellent exposure, but reported a 14.5% mortality rate related to extracorporeal circulation and problems with bleeding during rewarming (Uihlein et aI., 1966).…”

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confidence: 99%

Marked Protection by Moderate Hypothermia after Experimental Traumatic Brain Injury

Clifton¹,

Jiang²,

Lyeth³

et al. 1991

J Cereb Blood Flow Metab

505

175

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Summary: These experiments examined the effects of moderate hypothermia on mortality and neurological def icits observed after experimental traumatic brain injury (TBI) in the rat. Brain temperature was measured contin uously in all experiments by intraparenchymal probes, Brain cooling was induced by partial immersion (skin pro tected by a plastic barrier) in a water bath (OOe) under general anesthesia (1.5% halothane170% nitrous oxide/ 30% oxygen). In experiment I, we examined the effects of moderate hypothermia induced prior to injury on mortal ity following fluid percussion TBI. Rats were cooled to 36°e (n = 16), 33°e (n = 17), or 300e (n = II) prior to injury and maintained at their target temperature for I h after injury. There was a significant (p < 0.04) reduction in mortality by a brain temperature of 30oe. The mortality rate at 36°e was 37.5%, at 33°e was 41 %, and at 300e wasThe cerebral protective effects of profound hypo thermia «18°C) have been known for many years. As early as 1950, reports of cerebral protection from global ischemia by profound hypothermia in animals stimulated clinical interest (Mohri and Me rendino, 1969). By 1955, 100 cardiac surgical cases had been performed under deep hypothermia with cardiac arrest (Mohri and Merendino, 1969). As pump oxygenators became more efficient, deep hy pothermia and cardiac arrest were only occasion ally used in adult cardiac surgery (Crawford and Saleh, 1981). In pediatric cardiac surgery, however, conditions were encountered routinely where total cessation of circulation at temperatures of 17-20°C Abbreviations used: ANOYA, analysis of variance; TB1, trau matic brain injury, 114 9.1 %. In experiment II, we examined the effects of mod erate hypothermia or hyperthermia initiated after TBI 01 long-term behavioral deficits. Rats were cooled to 36°e (I = 10), 33°e (n = 10), or 300e (n = 10) or warmed to 38°( (n = 10) or 400e (n = 12) starting at 5 min after injury an( maintained at their target temperatures for I h. Hypother mia-treated rats had significantly less beam-walking beam-balance, and body weight loss deficits compared t( normothermic (38°C) rats. The greatest protection wa: observed in the 300e hypothermia group, Since a temper ature of 300e can be induced in humans by surface cool ing without coagulopathy or ventricular fibrillation, hy pothermia to 300e may have potential clinical value fOJ treatment of human brain injury.

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confidence: 99%

Marked Protection by Moderate Hypothermia after Experimental Traumatic Brain Injury

Clifton¹,

Jiang²,

Lyeth³

et al. 1991

J Cereb Blood Flow Metab

505

175

View full text Add to dashboard Cite

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“…Deep hypothermic circulatory arrest was first used for resection of a brain tumor by Woodhall et al in 1960 [10]. There was great initial enthusiasm with deep hypothermic circulatory arrest in neurosurgery, mainly in the treatment of intracranial aneurysms, and many centers began applying this technique [5,6,11]. This initial enthusiasm subsided once the complications associated with deep hypothermic circulatory arrest (eg, intraoperative and postoperative hemorrhage, arterial dissection and/or occlusion in the cannulation site, trauma to red blood cells and platelets, and electrolyte abnormalities as a result of hypothermia) became evident.…”

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confidence: 99%

Deep hypothermic circulatory arrest for treatment of renal carcinoma

Gorji

Wang

Eller

et al. 2009

Journal of Clinical Anesthesia

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“…The precise application of aneurysm clips and/or endoaneurysmorraphy is made possible, allowing preservation of the patient artery and maintenance of the continuity of associated branches, all of which can lower mobility and mortality. 2,3,[7][8][9][10] In the literature, there are very few large series of complex intracranial aneurysm treated under DHCA.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Furthermore, the introduction of the closed-chest approach, via femoral cannulation with the chest closed and without direct access to the heart (CCDHCA), has increased the use of this technique in neurosurgery. [4][5][6][7][8][9][10] We describe the anesthetic and intensive care management of a sequential cohort of patients, with complex cerebral aneurysms, prospectically treated by the same team under CCDHCA.…”

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confidence: 99%

Giant Intracranial Aneurysms Treated With Deep Hypothermia and Circulatory Arrest

Levati¹,

Tommasino

Moretti³

et al. 2007

Journal of Neurosurgical Anesthesiology

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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.

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Deep Hypothermia and Surgical Treatment of Intracranial Aneurysms

Cited by 37 publications

References 8 publications

Marked Protection by Moderate Hypothermia after Experimental Traumatic Brain Injury

Marked Protection by Moderate Hypothermia after Experimental Traumatic Brain Injury

Deep hypothermic circulatory arrest for treatment of renal carcinoma

Giant Intracranial Aneurysms Treated With Deep Hypothermia and Circulatory Arrest

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