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Eur J Cardiothorac Surg 1998;13:223-229
© 1998 Elsevier Science NL

Deep hypothermia and circulatory arrest for surgery of complex intracranial aneurysms¹

^a Department of Thoracic and Cardiovascular Surgery, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, D93042 Regensburg, Germany
^b Department of Neurosurgery, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, D93042 Regensburg, Germany
^c Department of Anesthesiology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, D93042 Regensburg, Germany

Received 27 October 1997; received in revised form 29 December 1997; accepted 14 January 1998.

Corresponding author. Tel.: +49 941 9449801; fax: +49 941 9449802.

Objective: Some intracranial aneurysms may not be operable by conventional neurosurgery due to their location or morphology. Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest renders surgery of these complex aneurysms possible. Brain temperatures can be measured directly in this setting. Methods: Eight patients with complex intracranial aneurysms were operated on with the aid of CPB. Femoro-femoral bypass with heparin-coated circuit components was used in all cases. Venous drainage was augmented by a centrifugal pump in six patients and by a newly developed vacuum technique in two patients. Temperatures were monitored by probes in brain, tympanum, nasopharynx, bladder, rectum, arterial and venous blood. These measurements were recorded on-line together with those of cerebral oxygen saturation, AP, CVP and PAP. Blood gas analyses and an EEG were also performed continuously. Results: Outcome was excellent in seven patients, in one patient moderate neurological disability occured. Mean time on cardiopulmonary bypass was 160 (117–215) min, for cooling to a brain temperature of 18°C 33 (20–47) min, and for total circulatory arrest 27 (15–45) min. Additionally, terminal brain arteries were clamped for up to 68 min in four patients. No cardiac complications were observed. Actual brain temperatures were best reflected by the tympanum probes (max. deviation 2°C), whereas temperatures measured in bladder or rectum exhibited deviations of up to 10°C. EEG activities were arrested between brain temperatures of 19 and 26°C. Conclusions: Complex intracranial aneurysms can be treated successfully using deep hypothermic circulatory arrest. Extensive monitoring adds to the speed and safety of the procedure. The resulting comparative measurements of temperatures at different body sites including brain, EEG, and other variables may be of general relevance for operations employing deep hypothermia and circulatory arrest.

Key Words: Intracranial aneurysms • Extracorporeal circulation • Deep hypothermia • Brain temperature

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