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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
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A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing: A CARE compliant case report

Yi Ping1, Huahua Gu

  • 1Department of Anesthesiology, Huashan Hospital Fudan University, Shanghai, China.

Medicine
|December 5, 2018
PubMed

Insights

Rapid ventricular pacing (RVP) effectively reduces blood pressure during cerebral aneurysm surgery, lowering risks of rupture and hemorrhage. This method provides a safe window for clipping aneurysms, improving patient outcomes.

Area of Science:

  • Neurosurgery
  • Cardiovascular Physiology
  • Medical Technology

Background:

  • Cerebral aneurysms are a leading cause of stroke and death, often treated with invasive surgery.
  • Surgical risks include aneurysm rupture, leading to severe neurological damage or mortality.
  • Rapid ventricular pacing (RVP) is a technique to transiently lower blood pressure by increasing heart rate.

Observation:

  • A 46-year-old patient presented with chronic headaches and recent neurological deficits.
  • Diagnostic imaging confirmed a large right middle cerebral artery (MCA) aneurysm.
  • RVP was employed during surgical repair to mitigate procedural risks.

Findings:

  • The patient underwent successful MCA aneurysm repair with RVP.
  • Post-procedure imaging showed no residual aneurysm or complications.
  • Neurological function improved, with motor strength grading V on the right and IV on the left extremities at seven weeks.

Implications:

  • RVP offers a safe and effective strategy for transiently reducing cardiac output in intracranial aneurysm surgery.
  • This technique can create a critical "low pressure" state, facilitating safer aneurysm clipping, especially in rupture scenarios.
  • RVP may improve surgical safety and reduce the risk of catastrophic outcomes in complex cerebrovascular procedures.
Abstract

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