Centrifugal pumps and heparin-coated circuits in surgical treatment of giant cerebral aneurysms

Giant cerebral aneurysms may be untreatable by conventional neurosurgical t echniques. Early attempts to use circulatory assistance and deep hypothermi a were abandoned due to hemorrhagic complications. More recently, interest in circulatory support for complex neurosurgical procedures has been renewe d. A consecutive series of 8 patients were operated on for giant cerebral a neurysms with the combined use of deep hypothermia. The protocol included c areful preoperative cardiovascular assessment, perfect intraoperative syner gy between neurosurgical and cardiac teams, minimally invasive peripheral v ascular access including two femoral vein (21 F) and single arterial (17 F) femoral cannulation, use of total Carmeda coating on BioMedicus pumps in c losed circuits, and reduced heparinization without Protamine reversal. All cerebral aneurysms were successfully treated through deep hypothermia (15-1 8 degrees C) as assessed by intraoperative fluoroscopic controls and Dopple r vascular assessment. Mean circulatory support time was 174.2 +/- 29.6 min . Circulatory arrest period was 20 +/- 12 min. All patients survived and we re extubated within 48 h. No major deficit was observed clinically or on po stoperative CT scan. No hemorrhagic complications occurred (mean transfusio ns was 2.2 blood units). This work supports an extensive use of heparin-coa ted surfaces for complex circulatory assist techniques, either for cardiac or extra cardiac complex procedures.