Background: Vascular neurosurgery faces the controversial discussion about the need for deep hypothermia and circulatory arrest (dh/ca) for the treatment of complex cerebral aneurysms. In this retrospective analysis, we present our experience in the treatment of 26 giant and large cerebral aneurysms under profound hypothermia and circulatory arrest.
Methods: All patients were treated surgically under dh/ca. Seventeen patients had aneurysms of the anterior circulation, and nine patients had aneurysms of the posterior circulation. Thrombosis or calcification was found in ten patients. Eleven patients presented with subarachnoid hemorrhage. The seven patients with the longest circulation arrest time were analyzed in detail.
Results: Subarachnoid hemorrhage led to hospital admission in 42% (n = 11) of cases. The overall mortality was 11.5%, and the overall morbidity was 15%. Ten patients deteriorated transiently but fully recovered. The mean age, Glasgow Coma Score, Fisher, and Hunt and Hess Score correlated significantly with the long-term outcome. Circulation arrest time correlated significantly to the neurological outcome on discharge. All patients with prolonged circulation arrest times had wide aneurysmal necks, and four had adjacent vessels to the dome or the parent vessel included in the neck. We observed a significant increase of neurological deficits immediately postoperatively, but this neurological deterioration resolved over time.
Conclusions: We observed neurological deterioration immediately postoperatively in 13 patients, but all patients fully recovered within 6 months except for four patients. A long cardiac arrest time reflected complex pathoanatomical conditions. We conclude that the clipping procedure under deep hypothermia and circulatory arrest remains a pivotal armament in complex vascular neurosurgery.