Abstract
Direct surgical treatment of technically difficult or inoperable vascular lesions of the brain may become possible or safer using profound hypothermia and circulatory arrest.
A 40-year-old woman suffered from a subarachnoid hemorrhage. Angiography showed a large thrombosed and broad-based aneurysm arising from P2 portion of the right posterior cerebral artery (PCA). The patient underwent a right fronto-temporal craniotomy under hypothermic circulatory arrest at 19.6°C.
After exsanguination the aneurysmal sac was opened and the thrombus was removed. The artery was reconstructed by putting 3 long clips across the broad neck, which left the PCA slightly dilated. Postoperatively, she awoke with right oculomotor nerve paresis, left hemiparesis, and left homonymous hemianopsia, which improved later. Angiography showed complete obliteration of the aneurysm.
This initial experience indicates that patients with giant and thrombosed aneurysms might benefit from a surgical approach that includes the use of deep hypothermic circulatory arrest.
