Review

Review of Deep Hypothermia and Circulatory Arrest Techniques For Surgical Repair of Giant Cerebral Aneurysms

Columbia-Presbyterian Medical Center, Milstein Hospital, New York, New York

^* Address correspondence to: Linda B. Mongero, CCP, Columbia-Presbyterian Medical Center, Milstein Hospital, Building 4-350, New York, NY 10032-3784

Abstract

Early experience in the 1960s with the repair of giant cerebral aneurysms utilizing cardiopulmonary bypass (CPB) with deep hypothermia and circulatory arrest was reviewed. However, due to the complications associated with CPB, its use was abandoned in the early 1970's. Surface cooling alone with open chest cardiac massage was then employed successfully in a series of neurosurgical patients.

Reintroduction of bypass techniques for core cooling using peripheral cannulation combined with neurosurgical advances has decreased the morbidity associated with this technique in the 1980s. However, some centers continue to perform these procedures with open chest cardiopulmonary bypass. Although there are advantages to the open chest technique, it is no longer necessary in most patients. With a long thin-walled venous cannula advanced from the femoral vein to the right atrium, combined with a centrifugal pump in the venous line, adequate venous return and cardiac decompression can be achieved without the need for a sternotomy. Advances in perfusion techniques and anesthetic monitoring are the hallmarks of the successful outcome in neurosurgical repairs of giant cerebral aneurysms in the 1990s.