Related Experiment Video
Updated: Jul 18, 2026
Establishment of Deep Hypothermic Circulatory Arrest in Rats
Published on: December 16, 2022
Giant intracranial aneurysms treated with deep hypothermia and circulatory arrest
Anna Levati1, Concezione Tommasino, Maria Pia Moretti
1Neurointensive Care Unit, Niguarda Hospital, Milano, Italy. lev_anna2002@yahoo.it
Insights
Deep hypothermic circulatory arrest (DHCA) with a closed chest (CCDHCA) offers a safe and effective surgical option for large and giant cerebral aneurysms, achieving a 0% mortality rate.
Area of Science:
- Neurosurgery
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Large and giant cerebral aneurysms pose significant surgical challenges.
- Conventional surgical techniques may not be suitable for all complex aneurysms.
Purpose of the Study:
- To evaluate the safety and efficacy of closed-chest deep hypothermic circulatory arrest (CCDHCA) for treating large and giant cerebral aneurysms.
- To assess patient outcomes, including mortality and neurological complications.
Main Methods:
- Twelve patients with large/giant cerebral aneurysms underwent CCDHCA for surgical clipping or trapping.
- Comprehensive intraoperative monitoring included brain and core temperatures, pressures, electroencephalography, and evoked potentials.
- Deep hypothermia was maintained with mean brain temperatures around 15.1°C and core temperatures around 14.1°C.
Main Results:
- Mean circulatory arrest time was 26.5 minutes.
- No deaths occurred during the follow-up period (up to 70 months).
- Good recovery (Glasgow Outcome Scale) was observed in 9 patients, with 1 moderate and 2 severe disabilities.
Conclusions:
- CCDHCA is a successful and viable surgical approach for selected patients with complex cerebral aneurysms.
- The technique demonstrated a 0% mortality rate and manageable neurological complication rates (25%).
Abstract:
The use of deep hypothermic circulatory arrest (DHCA), using groin cannulation with the chest closed (CCDHCA), has improved the surgical treatment of large and giant cerebral aneurysms. Twelve consecutive ASA I-II patients (10 women and 2 men), with a mean age of 35 years (range 14 to 55 y) underwent DHCA for clipping or trapping of their aneurysm (giant, n=10; large, n=2; 42% posterior circulation), under balanced general anesthesia. Intraoperative standard monitors were completed with jugular oxygen saturation, pulmonary artery, pulmonary artery occlusion, central venous pressures, electroencephalography, evoked potentials, and cerebral (subdural), and core temperature. At the start of circulatory arrest, brain temperature was 15.1+/-1.1 degrees C (range 13.5 to 17.5), and core temperature 14.1+/-1.1 degrees C (range 12.7 to 17.0). Mean circulatory arrest time was 26.5+/-13.9 minutes (range 9 to 54) and anesthesia lasted 14+/-1 hours. Only one patient underwent DHCA with standard sternotomy, because of aortic insufficiency. Follow-up (up to 70 mo) revealed no deaths and Glasgow Outcome Scale at 6 months revealed good recovery in 9, moderate disability in 1, and severe disability in 2 patients. Selected patients with large/giant intracranial aneurysms, deemed unapproachable by conventional surgical techniques, were successfully treated using CCDHCA. Mortality rate was 0% and neurologic complications occurred in 25% of the patients.
