Giant Intracranial Aneurysms Treated With Deep Hypothermia and Circulatory Arrest

Abstract

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.

Hypothermia treatment potentiates ERK1/2 activation after traumatic brain injury

“…Extending these results to a postinjury paradigm is essential to determine whether ERK1/2 is also potentiated with post‐TBI hypothermia therapy. Pre‐cooling the brain prior to trauma is relevant to cardiovascular and cerebrovascular surgeries to attenuate damage from cerebral ischemia (Rothoerl & Brawanski, 2006; Harrington et al ., 2007; Levati et al ., 2007). Exposure to a nonlethal stressor prior to injury (i.e.…”

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

“…In selected patients with giant aneurysms, deep hypothermia with circulatory arrest under cardiopulmonary extracorporeal circulation has been shown to be a feasible and possibly useful technique, but outcome data are lacking. [192][193][194][195][196] Transient cardiac pause induced by adenosine has been used to control bleeding from intraoperative aneurysm rupture or to decompress large aneurysms and facilitate aneurysm clip application 197,198 ; however, controlled studies are needed to validate this intervention.…”

Deep Hypothermia Markedly Activates the Small Ubiquitin-Like Modifier Conjugation Pathway; Implications for the Fate of Cells Exposed to Transient Deep Hypothermic Cardiopulmonary Bypass

“…To protect organs from ischemic damage, surgery is usually performed during deep hypothermia. Deep hypothermic circulatory arrest or low-flow CPB has long been practiced in the repair of congenital heart disease in neonates, and of aneurysms of the thoracic aorta and giant intracranial aneurysms in adult patients (Mahle et al, 2000;Gega et al, 2007;Levati et al, 2007;Tabbutt et al, 2008). Although the protective potential of deep hypothermia is unquestionable, little is known about the mechanisms through which it protects organs or how to maximize its efficacy.…”