Extracorporeal circuit design considerations for giant intracranial aneurysm repair

Abstract

Clinical perfusionists must be able to modify the existing extracorporeal circuit in order to accommodate a specific surgical pathology. The clipping of a giant intracranial middle cerebral artery aneurysm, unapproachable with conventional neurosurgical techniques, required the use of a modified closed cardiopulmonary bypass circuit combined with deep hypothermia and total circulatory arrest. In-hospital discussions with anaesthesia, cardiac surgery, neurosurgery, and cardiology enabled an informed team approach directed towards the successful treatment of this complex neurosurgical lesion.

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References

Miller DC. Surgical management of aortic dissection: indications, preoperative management and long term results. In: Dorghazi RM , Slater EE eds. Aortic dissection. New York: McGraw-Hill , 1984: 193-243.

Crawford SE , Saleh SA , Schuessler JS. Treatment of aneurysm of transverse aortic arch . J Thorac Cardiovasc Surg 1979; 78: 383-393 .

Hess PJ , Howe Jr HR , Robicsek F et al. Traumatic tears of the thoracic aorta: improved results using BioMedicus pump . Ann Thorac Surg 1989; 4: 6-9 .

Diehl JT , Payne DD , Rastegar H , Cleveland RJ. Arterial bypass of the descending thoracic aorta with the BioMedicus centrifugal pump . Ann Thorac Surg 1987; 44: 422-423 .

Toomasian JM , Sarris E , Heck CF , Shuttleworth P , Miller DC. Perfusion techniques for type A and type B aortic dissections . Proc Am Acad Cardiovasc Perfusion 1993; 14: 62-70 .

Hollingsed MJ , Valenzuela R , Vasilakis A , Graeber GM , Stullken E , Murray GF. Clinical perfusion support of aortic aneurysms . Proc Am Acad Cardiovasc Perfusion 1993; 14: 71-76 .

Chanyi S , Wright A. Retrograde cerebral perfusion with profound hypothermia: an alternative method of cerebral protection . Proc Am Acad Cardiovasc Perfusion 1993; 15: 134-137 .

Meaney KM. Continuous retrograde cerebral perfusion via the superior vena cava . Proc Am Acad Cardiovasc Perfusion 1993; 15: 138-140 .

Solomon RA , Smith CR , Raps EC , Stone G , Fink ME. Deep hypothermic circulatory arrest for the management of complex anterior and posterior circulation aneurysms . Neurosurg 1991; 29: 732-738 .

10.

Jolin A , Eden E , Berggren H et al. Management of a giant intracranial aneurysm using surface-heparinized extracorporeal circulation and controlled deep hypothermic low flow perfusion: a case report . Acta Anaesthesiol Scan 1993; 37: 756-760 .

11.

Solomon L , Sutter FP , Goldman SM , Mitchel JM , Casey K. Augmented femoral return . Ann Thorac Surg 1993; 55: 1262-1263 .

12.

Fried DW , Zombolas TL , Weiss SJ. Single pump mechanically aspirated venous drainage (SPMAVD) for cardiac reoperation . Perfusion 1995; 10: 327-332 .