gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Hypothermic circulatory arrest in cerebral aneurysm surgery following acute subarachnoid hemorrhage

Hypothermer Kreislaufstillstand zur operativen Versorgung zerebraler Aneurysmen im akuten Stadium der Subarachnoidalblutung

Meeting Abstract

  • corresponding author Ralf Rothoerl - Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität Regensburg, Regensburg
  • C. Meyer - Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität Regensburg, Regensburg
  • T. Finkenzeller - Institut für Radiologie, Klinikum der Universität Regensburg, Regensburg
  • O. W. Ullrich - Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität Regensburg, Regensburg
  • A. Brawanski - Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität Regensburg, Regensburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 09.90

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0373.shtml

Veröffentlicht: 23. April 2004

© 2004 Rothoerl et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Hypothermic circulatory arrest is a well-described method for the surgical treatment of complex cerebrovascular lesions. Reports in the literature focus on hypothermic circulatory arrest in the post acute phase after aneurysmal subarachnoid hemorrhage. However this technique seems to be ideal for the treatment of complex aneurysms in the acute phase after SAH when a complicating brain edema is present. To the best of our knowledge, there is no series published focussing on employing this technique in the acute phase after aneurysmal SAH.

Methods

During a timespan in which nearly 700 cerebral aneurysms were treated in our institution, we felt that 5 patients suffering from acute aneurysmal SAH would benefit from being operated on by employing hypothermic circulatory arrest. An endovascular procedure was not possible in these cases. All patients were admitted within 2 days after aneurysmal SAH. Surgery was performed within 9 days after SAH (mean 5.4 days, range 4-9 days). All patients suffered from giant or complex aneurysms, 3 in the anterior and 2 in the posterior circulation. A standard hypothermic circulatory arrest protocol was employed.

Results

Cooling time was below 30 minutes in all cases. Brain temperature reached a mean of 18°C (range 18°C to19 °C). Circulatory arrest time was 150 minutes mean with a range from 87min to 2 hours. All aneurysms could be clipped successfully. No permanent procedure-related morbidity or mortality was observed. According to the Glasgow Outcome Scale, 4 patients reached a favourable outcome after 6 months (3 patients GOS 5 and 1 patient GOS 4), 1 patient died within 8 days after surgery due to a septic multi organ failure.

Conclusions

We report on a high risk population after subarachnoid hemmorrhage. In these selected cases, hypothermic circulatory arrest seems to be a safe alternative even in the acute phase after SAH, because outcome data does not differ from unselected patients after aneurysmal subarachnoid hemorrhage. However, indications are limited to small subgroup of patients.