MANAGEMENT OF A GIANT INTRACRANIAL ANEURYSM USING SURFACE-HEPARINIZEDEXTRACORPOREAL-CIRCULATION AND CONTROLLED DEEP HYPOTHERMIC LOW-FLOW PERFUSION - A CASE-REPORT

Extracorporeal circulation with controlled hypothermic low flow perfus ion was introduced during the surgical treatment of a patient with a g iant intracranial aneurysm of the anterior communicating artery. Hepar in-coated equipment (Carmeda Bio-Active Surface; CBAS) was utilized, t hus reducing the need for systemic heparinization. Direct cannulation of the right atrium and aorta was established through thoracotomy. Blo od flow through the circuit was kept at 4.5 l/min during normothermia. Core cooling, in combination with external surface cooling, was perfo rmed for 30 min to a temperature of 18-degrees-C (nasopharynx). During a period of 25 min, the time for surgical repair of the aneurysm, blo od flow was minimized to 0.41 . min-1, equilibrating central and perip heral blood pressures to approximately 5-10 mmHg (0.65-1.3 kPa). Reper fusion was started immediately after the low flow period concomitantly with rewarming, aiming at a temperature of 36-degrees-C following 150 min. The patient could be weaned off the extracorporeal circulation w ith minimal inotropic support. The postoperative course was uneventful apart from a left-sided hemiparesis, probably due to an infarction in the area of the right pericallosal artery (A2). The patient was weane d off the ventilator after 6 days. He recovered and the hemiparesis re gressed slowly.