Deep Hypothermic Circulatory Arrest for Complex Cerebral Aneurysms

Abstract

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.

Treatment Strategies for Complex Intracranial Aneurysms: Review of a 10-Year Experience at the University of Cincinnati

“…2,4,6,9,12,21,31,32 On the endovascular side, improved coils and stents provide better options for the treatment of complex aneurysms for which a high morbidity would be expected relative to a surgical approach, or for those patients with high surgical risk or severe SAH that would increase surgical complexity. That is reflected in our selection of endovascular procedures for the treatment of ruptured posterior-circulation aneurysms.…”

“…Unfortunately, in that respect, most recent publications consist of endovascular series, and site-specific series comparing coiling versus clipping for cerebral aneurysms. 2,4,5,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]27,31,32, While these comparisons between competing techniques are obviously expected to occur, we feel that, as endovascular treatment for aneurysms continues to evolve and find its definite place in the therapeutic armamentarium, its proven benefits are best weighed in a multidisciplinary, complementary approach. We have experienced the benefits of this therapeutic philosophy as the natural evolution of a collaborative approach to these complex lesions from all possible therapeutic approaches to improve our patient outcomes.…”

“…Other techniques reported by others, such as intraoperative hypothermia and adenosine-induced transient cardiac standstill, have not been used by our group. 6,12 Endovascular techniques were performed by our neurointerventionalist partners whose array of procedures included coiling, stenting, and use of embolic agents.…”

The Role of Deep Hypothermic Cardiac Arrest in the Surgical Treatment of Complex Intracranial Aneurysms

“…19 In a group of 66 patients treated, with a mean age of 49 years (range 15-73 years), 77 % harboured unruptured aneurysms. In 20 % of cases a previous unsuccessful treatment had been attempted.…”

“…We have therefore opted to focus our attention on the series published in the last four years accounting for the largest population of patients treated with this technique in North American and European institutions [19][20][21] (see Table 2). …”