gms | German Medical Science

Objective: Cerebral aneurysms are highly variable which may result in difficult surgical exposure for clip ligation in particular cases. Secure clip application is often not feasible without temporarily reducing intraaneurysmal pressure. This softening can be accomplished with transient clip ligation of parent vessels or with deep hypothermic circulatory arrest and cardiopulmonary bypass. Both manoevers have their own specific risks. A novel alternative method is adenosine-induced asystole. We describe our preliminary experience with this novel technique.

Method: We analyzed demographic data, aneurysm characteristics, reason for adenosine use, application characteristics, radiological and clinical outcome, and procedure specific complications.

Results: Four patients (3 women, 1 man; mean age 50,8 years) underwent microsurgical clipping of intracranial aneurysms (paraclinoid internal carotid artery in 3 patients, anterior communicating artery in 1 patient). Two patients had suffered a subarachnoid hemorrhage from aneurysm rupture, 2 patients had carried incidental aneuryms. Reasons for adenosine application were impracticality of temporary proximal vessel clipping (3 patients with paraclinoid internal carotid artery aneurysm) or a thin aneurysm neck (1 patient with an anterior communicating artery aneurysm). Mean adenosine dosage was 21 mg (range 15-30 mg) with a mean cardiac and flow arrest of 15 sec (range 5-20 sec). In all patients adenosine-induced asystole facilitated clip application. No procedural complications were noticed. Postoperative femoral angiography showed complete aneurysm occlusion in all patients and cranial computed tomography revealed no cerebral infarction.

Conclusions: Adenosine-induced transient cardiac arrest is a suitable technique for decompression of intracranial aneurysms in order to facilitate clip ligation in selected patients.