Current Perfusion Techniques for Repair of Giant Cerebral Aneurysms using Deep Hypothermia and Circulatory Arrest

Intracerebral aneurysms unapproachable with conventional techniques can be clipped during total circulatory arrest under deep hypothermia. In a series of 30 cases, cardiopulmonary bypass techniques were developed which permit efficient core cooling and rewarming with peripheral (femoral-femoral) cannulation. The perfusion circuit was modified to use the centrifugal pump to apply negative pressure to the venous line without sacrificing the ability to rapidly add and subtract volume, and incorporated protection against air embolism by suction entrainment. Protection of the fibrillating heart during hypothermia was facilitated by transesophageal echo monitoring of the ventricular volume to detect distension. Conversion to central cannulation through median sternotomy was required in three patients (10%) because of inadequate venous return in two patients and severe iliac atherosclerosis in one patient. Early in the series there were two deaths (7%) from aortic dissection. The neurosurgical result, in otherwise inoperable patients, was successful in 90% of the cases.