Cardiac standstill for cerebral aneurysms in 103 patients: an update on the experience at the Barrow Neurological Institute

Clinical article

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Object

The aim of this study was to clarify the surgical indications, risks, and long-term clinical outcomes associated with the use of deep hypothermic circulatory arrest for the surgical treatment of intracranial aneurysms.

Methods

The authors retrospectively reviewed 105 deep hypothermic circulatory arrest procedures performed in 103 patients (64 females and 39 males, with a mean age of 44.8 years) to treat 104 separate aneurysms. Patients' clinical histories, radiographs, and operative reports were evaluated. There were 97 posterior circulation aneurysms: at the basilar apex in 60 patients, midbasilar artery in 21, vertebrobasilar junction in 11, superior cerebellar artery in 4, and posterior cerebral artery in 1. Seven patients harbored anterior circulation aneurysms. Two additional patients harbored nonaneurysmal lesions.

Results

Perioperatively, 14 patients (14%) died. Five patients (5%) were lost to late follow-up. At a mean long-term follow-up of 9.7 years, 65 patients (63%) had the same or a better status after surgical intervention, 10 (10%) were worse, and 9 (9%) had died. There were 19 cases (18%) of permanent or severe complications. The combined rate of permanent treatment-related morbidity and mortality was 32%. The mean late follow-up Glasgow Outcome Scale score was 4, and the annual hemorrhage rate after microsurgical clipping during cardiac standstill was 0.5%/year. Ninety-two percent of patients required no further treatment of their aneurysm at the long-term follow-up.

Conclusions

Cardiac standstill remains an important treatment option for a small subset of complex and giant posterior circulation aneurysms. Compared with the natural history of the disease, the risk associated with this procedure is acceptable.

Abbreviations used in this paper: CVA = cerebrovascular accident; GOS = Glasgow Outcome Scale; ICA = internal carotid artery; MCA = middle cerebral artery; PCA = posterior cerebral artery; SAH = subarachnoid hemorrhage; SCA = superior cerebellar artery.

Article Information

Current address for Dr. Han: St. John Health System, Tulsa, Oklahoma.

Address correspondence to: Robert F. Spetzler, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@chw.edu.

Please include this information when citing this paper: published online October 15, 2010; DOI: 10.3171/2010.9.JNS091178.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graph showing the outcome of patients with unruptured and ruptured aneurysms after surgical treatment with hypothermic cardiac arrest. At the late follow-up, 6 patients—4 with an unruptured and 2 with a ruptured aneurysm—had died of causes unrelated to their treatment or lesion. They are included in the category of same/better, their condition at the time of death.

  • View in gallery

    Graph showing surgical outcome as a function of aneurysm location. Ant. Circ. = anterior circulation; VBJ = vertebrobasilar junction.

  • View in gallery

    Graph showing the total number of cardiac standstill procedures performed at our institution between 1985 and 2005 for the treatment of all aneurysms compared with the number of procedures performed only for basilar tip aneurysms (BTA).

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