Even with modern endovascular techniques, very large or giant complex posterior circulation aneurysms represent formidable treatment challenges. In the present issue of the Journal of Neurosurgery, the group from the Barrow Neurological Institute5 presents their updated experience with 105 cardiac standstill procedures in 103 patients with very large or giant aneurysms. More than 90% of these procedures were performed for posterior circulation aneurysms.
While cardiocirculatory arrest provides a bloodless field, softens the aneurysm, and facilitates isolation of the neck and separation from critical perforators, this procedure adds incredible complexities, which relate mostly to the high level
HeppnerPAEllegalaDBRobertsonNNemergutEJaganathanJMeeE: Basilar tip aneurysm—adenosine induced asystole for the treatment of a basilar tip aneurysm following failure of temporary clipping. Acta Neurochir (Wien)149:517–5202007
PonceFASpetzlerRFHanPPWaitSDKilloryBDNakajiP: Cardiac standstill for cerebral aneurysms in 103 patients: an update on the experience at the Barrow Neurological Institute. Clinical article. J NeurosurgPublished online October 15 2010; DOI: 10.3171/2010.9.JNS091178
SteinbergGKDrakeCGPeerlessSJ: Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients. J Neurosurg79:161–1731993