Search Results

You are looking at 1 - 10 of 270 items for :

  • "circulatory arrest" x
Clear All
Restricted access

Robert A. Feldman, David Yashon, George E. Locke and William E. Hunt

L actate is known to accumulate in animal tissues as a result of anoxia. Lactate elevation has been quantitated in cerebral tissue following circulatory arrest and has been shown to increase in cerebral tissue after death, 5, 9 but such determinations have not been made on spinal cord tissue. This study explores the biochemical background for the chemical observation that, following profound central nervous system anoxia, the spinal cord tolerates anoxia better than the brain. Methods and Materials Eight rhesus monkeys weighing 3 to 5 kg were

Restricted access

Douglas Chyatte, John Elefteriades and Byung Kim

hypothermic circulatory arrest have stimulated renewed interest in these methods. 3, 7, 8 Profound hypothermia and circulatory arrest is used most commonly to facilitate surgical repair of giant intracranial aneurysms that would otherwise be inoperable. Oxygen requirements of the brain decrease exponentially as body temperature is lowered and, with deep hypothermia, total ischemia is well tolerated for 30 to 60 minutes. Today most neurosurgeons who use this technique establish extracorporeal circulation by cannulating the femoral vessels (closed chest method). Although

Restricted access

James I. Ausman, Patrick W. McCormick, Melville Stewart, Gary Lewis, Manuel Dujovny, Guruswamy Balakrishnan, Ghaus M. Malik and Ramsis F. Ghaly

S everal centers have demonstrated renewed interest in using profound hypothermia with induced circulatory arrest as a surgical adjunct for the management of complex cerebrovascular disease. 26, 28 This practice allows temporary collapse of large aneurysmal sacs, control of the parent vessel, and transient neuronal protection from hypoxia. 10, 12, 23 A major limitation of this adjunct is that cerebral oxygen delivery is completely stopped while cerebral oxygen metabolism (although greatly reduced by profound hypothermia) continues. Cerebral oxygen extraction

Restricted access

Edgar A. Bering Jr.

T his is a study of cerebrospinal fluid (CSF) electrolyte changes during circulatory arrest at brain temperatures ranging from 37° to 10° C and their relationship to cerebral oxygen metabolism. The maintenance of the intracellular sodium and potassium content is dependent on the metabolic processes which excludes or removes sodium from cells (the “sodium pump”). As the cerebral metabolism is, under normal conditions, almost entirely aerobic, the cerebral sodium pump is dependent directly on the availability of oxygen to the brain. Anoxia generated by

Restricted access

Werner Hassler, Helmuth Steinmetz and Jürgen Pirschel

S evere intracranial hypertension is accompanied by characteristic angiographic findings such as delayed, scarce, and tapering contrast filling of the intracranial arteries. With developing intracranial circulatory arrest, the dye column may terminate at any extracerebral level. 4, 8, 14, 15, 22 The unanimous opinion of these authors is that extradural arrest is unequivocal evidence of cerebral circulatory standstill. Disagreement has existed on whether “stasis filling” of subarachnoid arteries without subsequent venous drainage conformed with this diagnosis

Full access

Ralf Dirk Rothoerl and Alexander Brawanski

✓ After the development of deep hypothermia and circulatory arrest for cardiothoracic procedures in the late 1950s, this technique was adopted by several neurosurgeons as an aid to complex cranial surgery. Woodhall and colleagues described its first use for a neurosurgical procedure in 1960. Although their case did not involve a cerebrovascular procedure, the technique was subsequently used for the surgical treatment of cerebrovascular lesions, especially complex and giant aneurysms as well as large and solid hemangioblastomas. At the beginning, incorporation of this technique into common neurosurgical practice was impeded by several factors. For example, postbypass coagulopathy had been a serious source of morbidity. Furthermore, the need for cooperation among multiple subspecialities and the requirements for expensive equipment had further limited the availability of this technique. Subsequent improvements in the technique and advances in the equipment designed for cardiopulmonary bypass have led to its more widespread use starting in the 1980s. Hypothermic circulatory arrest has been described in several reports as a safe and useful tool in the treatment of large and giant aneurysms. Nevertheless, improvements in endovascular procedures and further refinement in skull base surgical techniques have limited the indications for circulatory arrest and deep hypothermia. The authors describe the history of hypothermia and circulatory arrest, its implementation in cerebrovascular surgery, and the changes in indications for and results of its use over time.

Restricted access

Neurosurgical Forum: Letters to the editor To The Editor Dwight Parkinson , M.D. University of Manitoba Winnipeg, Manitoba, Canada 333 333 Regarding the article by Ausman, et al. (Ausman JI, McCormick PW, Stewart M, et al: Cerebral oxygen metabolism during hypothermic circulatory arrest in humans. J Neurosurg 79: 810–815, December, 1993), we used 10° to 12°C with 50-minute increments of circulatory arrest, sometimes as many as three per patient. Unfortunately, no psychological testing was done on any of these

Restricted access

Neurosurgical Forum: Letters to the editor To The Editor C. Dean Kurth , M.D. , Warren Levy , M.D. , Britton Chance , Ph.D. University of Pennsylvania School of Medicine Philadelphia, Pennsylvania 330 331 The article by Ausman, et al. (Ausman JI, McCormick PW, Stewart M, et al: Cerebral oxygen metabolism during hypothermic circulatory arrest in humans. J Neurosurg 79: 810–815, December, 1993) describes cerebrovascular hemoglobin-O 2 saturation (S c O 2 ) in adults during deep hypothermic

Restricted access

Robert F. Spetzler, Mark N. Hadley, Daniele Rigamonti, L. Philip Carter, Peter A. Raudzens, Steven A. Shedd and Elizabeth Wilkinson

aneurysms were successfully occluded at their neck. Giant aneurysms of the basilar artery were associated with even worse outcomes: only 52% of 73 patients with a basilar artery aneurysm had excellent or good results, 23% had poor outcomes, and 25% died. A useful adjunct available to the neurological surgeon in the treatment of complex intracranial vascular lesions is complete circulatory arrest. Several investigators have reported improved results when utilizing this technique in treating giant intracranial aneurysms, 3, 11, 28, 32, 35, 42, 54 of which only seven were

Restricted access

Neurosurgical Forum: Letters to the editor To The Editor T. J. Germon , F.R.C.S. , A. R. Manara , M.R.C.P., F.R.C.A. , N. M. Kane , M.Sc., F.R.C.S. , R. J. Nelson , F.R.C.S. Frenchay Hospital Bristol, England 331 333 Ausman and colleagues present data using transcutaneous near-infrared oximetry to study cerebral oxygenation during hypothermic circulatory arrest (Ausman JI, McCormick PW, Stewart M, et al: Cerebral oxygen metabolism during hypothermic circulatory arrest in humans