Deep hypothermic circulatory arrest for complex cerebral aneurysms: Lessons learned

William J. Mack, Andrew F. Ducruet, Peter D. Angevine, Ricardo J Komotar, Debra B. Shrebnick, Niloo M. Edwards, Craig R. Smith, Eric J. Heyer, Linda Monyero, E. Sander Connolly, Robert A. Solomon

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

OBJECTIVE: Deep hypothermic circulatory arrest is a useful adjunct for treating complex aneurysms. Decreased cerebral metabolism and resultant ischemic tolerance create an environment suitable for devascularizing high-risk lesions. However, the advent of modern imaging modalities, innovative cerebral revascularization strategies, and the emergence of endovascular stenting and coiling limit the number of aneurysms requiring this surgical intervention. We present 66 patients with intracranial aneurysms who underwent surgical clipping under deep hypothermic arrest and attempt to identify patients well-suited for this procedure. METHODS: This study was conducted during a 15-year period and examined patients with aneurysms of the anterior and posterior cerebral circulation. Demographics, aneurysm characteristics, and surgical factors were evaluated as predictors of functional outcome. RESULTS: Patient age and the duration of cardiac arrest were independent predictors of early clinical outcome (P < 0.05). Our experience suggests that the ideal patient is younger than 60 years old and harbors few medical comorbidities. Individuals with large aneurysms of the anterior communicating artery, internal carotid artery bifurcation, posterior inferior cerebellar artery, midbasilar, or vertebral arteries and with an absence of thrombosis and calcium may be most likely to experience favorable outcomes. Circulatory arrest should not exceed 30 minutes. Postoperative computed tomographic scanning and timely anesthetic emergence allow for early detection of hemorrhage. Complete dissection of the aneurysm before bypass and avoiding extreme hypothermia yield a low incidence of life-threatening postoperative hematomas. CONCLUSION: Hypothermic circulatory arrest is a useful technique for neuroprotection during the clipping of complex cerebral aneurysms. This procedure, however, has several associated risks. Patient factors, pathoanatomic characteristics, and surgical parameters may be used to guide patient selection.

Original languageEnglish
JournalNeurosurgery
Volume62
Issue number6 SUPPL.
DOIs
StatePublished - Jun 1 2008
Externally publishedYes

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Deep Hypothermia Induced Circulatory Arrest
Intracranial Aneurysm
Aneurysm
Cerebrovascular Circulation
Cerebral Revascularization
Vertebral Artery
Internal Carotid Artery
Heart Arrest
Hypothermia
Hematoma
Patient Selection
Anesthetics
Dissection
Comorbidity
Thrombosis
Arteries
Demography
Hemorrhage
Calcium
Incidence

Keywords

  • Aneurysm
  • Circulatory arrest
  • Hypothermia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Mack, W. J., Ducruet, A. F., Angevine, P. D., Komotar, R. J., Shrebnick, D. B., Edwards, N. M., ... Solomon, R. A. (2008). Deep hypothermic circulatory arrest for complex cerebral aneurysms: Lessons learned. Neurosurgery, 62(6 SUPPL.). https://doi.org/10.1227/01.NEU.0000255452.20602.C9

Deep hypothermic circulatory arrest for complex cerebral aneurysms : Lessons learned. / Mack, William J.; Ducruet, Andrew F.; Angevine, Peter D.; Komotar, Ricardo J; Shrebnick, Debra B.; Edwards, Niloo M.; Smith, Craig R.; Heyer, Eric J.; Monyero, Linda; Connolly, E. Sander; Solomon, Robert A.

In: Neurosurgery, Vol. 62, No. 6 SUPPL., 01.06.2008.

Research output: Contribution to journalArticle

Mack, WJ, Ducruet, AF, Angevine, PD, Komotar, RJ, Shrebnick, DB, Edwards, NM, Smith, CR, Heyer, EJ, Monyero, L, Connolly, ES & Solomon, RA 2008, 'Deep hypothermic circulatory arrest for complex cerebral aneurysms: Lessons learned', Neurosurgery, vol. 62, no. 6 SUPPL.. https://doi.org/10.1227/01.NEU.0000255452.20602.C9
Mack, William J. ; Ducruet, Andrew F. ; Angevine, Peter D. ; Komotar, Ricardo J ; Shrebnick, Debra B. ; Edwards, Niloo M. ; Smith, Craig R. ; Heyer, Eric J. ; Monyero, Linda ; Connolly, E. Sander ; Solomon, Robert A. / Deep hypothermic circulatory arrest for complex cerebral aneurysms : Lessons learned. In: Neurosurgery. 2008 ; Vol. 62, No. 6 SUPPL.
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