Artikel
Indications, techniques, outcome and complications of hypothermic circulatory arrest in cerebrovascular surgery: A twelve-year experience
Indikationen, Technik, Behandlungsergebnisse und Komplikationen der tiefen Hypothermie und des Herz-Kreislauf-Stillstandes in der zerebrovaskulären Chirurgie: 12 Jahre Erfahrung
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Autoren
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A. Brawanski
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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D. Fröhlich
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg
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F. Schmidt
- Kilinik und Poliklinik für Herz-Thorax-Chirurgie, Universitätsklinikum Regensburg
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A. Phillip
- Kilinik und Poliklinik für Herz-Thorax-Chirurgie, Universitätsklinikum Regensburg
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R. Rothoerl
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Cardiopulmonary bypass using deep hypothermia and circulatory arrest is routinely used for a number of cardiovascular procedures. After the development of cardiothoracic procedures in the late 1950's, this technique was discovered by several neurosurgeons as an aid to complex cranial surgery. Over the years there was a substantial change in indications and outcome after deep hypothermia and circulatory arrest. The aim of this study is to report our indications, technique and results.
Methods: We report only on patients undergoing surgery for aneurysm clipping. 24 patients were treated using hypothermic circulatory arrest and cardiopulmonary bypass. There were 12 female patients and 12 male patients. Mean age was 41,2 years with a range from 17 to 63 years at the time of surgery. Six of our patients underwent surgery using deep hypothermia and cardiopulmonary bypass for aneurysms of the posterior circulation. One patient was treated for a vertebral artery aneurysm and another 5 for lesions of the basilar artery. 9 were giant aneurysms. In 18 vascular lesions a broad neck (at least 3/4 of the maximal broadness) was present and 3 lesions were classified as fusiform.
Results: The surgical approaches used to treat the lesions included the standard pterional transsylvian approach in 18 patients, the subtemporal approach in two, the presigmoidal in another two and a bifrontal and a retromastoid in another patient each. All patients were clipped during cardiocirculatory arrest. The neck was either occluded by a clip, or the parent vessel was reconstructed using clips. 3 patients (12.5%) died within the perioperative phase. Another 3 patients developed a neurological deficit after surgery. No complication was attributed to deep hypothermia and circulatory arrest.
Conclusions: We report indications and surgical results in an extremely selected high risk population. Taking this into account and the fact that no complication could be attributed to deep hypothermia and circulatory arrest, we think that this procedure is safe and recommendable in a very limited number of cases.
