Profound hypothermia and circulatory arrest for aneurysm surgery

1989 ◽  
Vol 70 (3) ◽  
pp. 489-491 ◽  
Author(s):  
Douglas Chyatte ◽  
John Elefteriades ◽  
Byung Kim
Keyword(s):  
Extracorporeal Circulation ◽  
Circulatory Arrest ◽  
Artery Aneurysm ◽  
Vascular Lesions ◽  
Profound Hypothermia ◽  
Content Type ◽  
Closed Chest ◽  
Femoral Vessels ◽  
The Right ◽  
The Brain

✓ Direct surgical repair of technically difficult or otherwise inoperable vascular lesions of the brain may become possible or safer using profound hypothermia and circulatory arrest. Most surgeons who use this technique establish extracorporeal circulation by cannulating the femoral vessels. To avoid difficulties associated with this closed chest method, a method was devised to establish extracorporeal circulation, profound hypothermia, and circulatory arrest by direct cannulation of the right atrium and aorta through the chest. This technique is described in a patient whose otherwise inoperable vertebral artery aneurysm was successfully treated. This approach is simple and offers several advantages over the closed chest method.

Facial pain due to vascular lesions of the brain stem relieved by dorsal root entry zone lesions in the nucleus caudalis

1992 ◽  
Vol 77 (3) ◽  
pp. 473-475 ◽  
Author(s):  
John H. Sampson ◽  
Blaine S. Nashold
Keyword(s):  
Dorsal Root ◽  
Facial Pain ◽  
Artery Aneurysm ◽  
Vascular Lesions ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Radiofrequency Lesions ◽  
The Brain

✓ One patient with a pontine infarct due to a fusiform basilar artery aneurysm and one with an arteriovenous malformation within the tectum of the mesencephalon developed intractable facial pain. This pain was relieved in both patients by radiofrequency lesions in the dorsal root entry zone of the trigeminal nucleus caudalis.

Unilateral Antegrade Cerebral Perfusion Through the Right Axillary Artery Provides Uniform Flow Distribution to Both Hemispheres of the Brain

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Jian Ye ◽  
Guangping Dai ◽  
Lawrence N. Ryner ◽  
Piotr Kozlowski ◽  
Luojia Yang ◽  
...  
Keyword(s):  
Cerebral Blood Volume ◽  
Axillary Artery ◽  
Circulatory Arrest ◽  
Flow Distribution ◽  
Mr Perfusion ◽  
Mr Perfusion Imaging ◽  
Regional Cerebral Blood Volume ◽  
The Right ◽  
The Brain ◽  
Antegrade Cerebral Perfusion

Background —Bilateral antegrade cerebral perfusion (ACP) has decreased in popularity over the past decade because of its complexity and the risk of cerebral embolism. We used magnetic resonance (MR) perfusion imaging to assess flow distribution in both hemispheres of the brain during unilateral ACP through the right carotid artery via a cannula placed in the right axillary artery in conjunction with hypothermic circulatory arrest. Methods and Results —Twelve pigs were randomly exposed to 120 minutes of either bilateral ACP through both carotid arteries (n=6) or unilateral ACP through the right axillary artery (n=6) at pressures of 60 to 65 mm Hg at 15°C, followed by 60 minutes of cardiopulmonary bypass at 37°C. MR perfusion images were acquired every 30 minutes before, during, and after ACP. The brain was perfusion fixed for histopathology. During initial normothermic cardiopulmonary bypass, MR perfusion imaging showed a uniform distribution of flow in the brain. In both the bilateral and unilateral ACP groups, the same pattern was maintained, with an increase in regional cerebral blood volume during ACP and reperfusion. The changes in regional cerebral blood volume and mean transit time were similar in both hemispheres during and after unilateral ACP. No difference was observed between the 2 groups. Histopathology showed normal morphology in all regions of the brain in both groups. Conclusions —Both bilateral ACP and unilateral ACP provide uniform blood distribution to both hemispheres of the brain and preserve normal morphology of the neurons after prolonged hypothermic circulatory arrest.

The Brain Research Laboratory at the Cleveland Metropolitan General Hospital and Case Western Reserve University

2004 ◽  
Vol 101 (5) ◽  
pp. 881-887 ◽  
Author(s):  
Franklin C. Wagner
Keyword(s):  
General Hospital ◽  
Research Laboratory ◽  
Brain Research ◽  
Circulatory Arrest ◽  
Protective Effects ◽  
Content Type ◽  
Scientific Investigations ◽  
The Central Nervous System ◽  
The Brain ◽  
Western Reserve

✓ In 1961 Dr. Robert White, fresh from the Mayo Clinic, established the Brain Research Laboratory (BRL) at the Cleveland Metropolitan General Hospital, Cleveland, Ohio, under the auspices of Case Western Reserve University. During a span of 15 years, he and his colleagues contributed significantly to our knowledge and understanding of the central nervous system in deep hypothermic conditions, thus demonstrating the protective effects of cerebral and spinal cord cooling in patients with injuries as well as the ability of the brain to survive extended periods of total circulatory arrest at extremely low temperatures. It was there that isolated brain preparation and transplantation were first accomplished. These and other unique, surgically constructed brain models opened new fields of exploration in neurochemical, neurophysiological, rheological, immunological, and cognitive features of the brain in normothermic and various hypothermic states. During the laboratory's most productive years (1961–1976), there were 10 surgeons actively involved in scientific investigations who later became chairmen or chiefs of Departments or Divisions of Neurosurgery and another four who became professors of neurosurgery or other surgical specialties.

scholarly journals Clinical Experience with a Closed-chest Method of Producing Profound Hypothermia and Total Circulatory Arrest in Neurosurgery

1964 ◽  
Vol 159 (1) ◽  
pp. 125-131 ◽  
Author(s):  
JOHN D. MICHENFELDER ◽  
JOHN W. KIRKLIN ◽  
ALFRED UIHLEIN ◽  
HENDRIK J. SVIEN ◽  
COLLIN S. MACCARTY
Keyword(s):  
Clinical Experience ◽  
Circulatory Arrest ◽  
Profound Hypothermia ◽  
Closed Chest ◽  
Total Circulatory Arrest

Adenosine-induced transient asystole for management of a basilar artery aneurysm

1999 ◽  
Vol 91 (4) ◽  
pp. 687-690 ◽  
Author(s):  
Michael W. Groff ◽  
David C. Adams ◽  
Ronald A. Kahn ◽  
Uday M. Kumbar ◽  
Bo-Yi Yang ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Circulatory Arrest ◽  
Artery Aneurysm ◽  
Deep Hypothermic Circulatory Arrest ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Basilar Artery Aneurysm ◽  
Profound Hypotension ◽  
Definition Of ◽  
Temporary Clipping

✓ Advances in anesthetic and surgical management, such as induced deep hypothermic circulatory arrest and application of temporary clips, have improved outcome for patients with basilar artery aneurysms. Nonetheless, these techniques are associated with significant risks. The authors report a case in which three transient periods of cardiac asystole were induced during basilar artery aneurysm surgery. Adenosine-induced asystole facilitated the safe clipping of the aneurysm by producing consistent periods of profound hypotension and collapse of the aneurysm without the need for temporary clipping. This technique provided unencumbered identification of perforating arteries, precise definition of the local anatomy, and an ideal environment for the safe placement of the aneurysm clip.

Remote congenital cerebral arteriovenous fistulae associated with aortic coarctation

1992 ◽  
Vol 76 (1) ◽  
pp. 137-142 ◽  
Author(s):  
Francis H. Tomlinson ◽  
David G. Piepgras ◽  
Douglas A. Nichols ◽  
Daniel A. Rüfenacht ◽  
Sue C. Kaste
Keyword(s):  
Caesarean Section ◽  
Aortic Coarctation ◽  
Coarctation Of The Aorta ◽  
Vascular Lesions ◽  
Prenatal Ultrasonography ◽  
Arteriovenous Fistulae ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A neonate presented with anatomically discrete cerebral arteriovenous fistulae located in the right sylvian fissure and the cerebellar vermis that were initially detected by prenatal ultrasonography. Following delivery of the baby by Caesarean section, both malformations were treated by surgical obliteration. These intracranial vascular lesions were associated with cardiac anomalies and a periductal coarctation of the aorta, which was treated with a left subclavian rotational arterial pedicle repair. Follow-up examination of the infant at age 13 months demonstrated an excellent clinical result with normalization of the circulation. The pathophysiology of this syndrome is discussed and the literature reviewed.

scholarly journals Fonsecaea pugnacius, a Novel Agent of Disseminated Chromoblastomycosis

2015 ◽  
Vol 53 (8) ◽  
pp. 2674-2685 ◽  
Author(s):  
Conceição M. P. S. de Azevedo ◽  
Renata R. Gomes ◽  
Vania A. Vicente ◽  
Daniel W. C. L. Santos ◽  
Sirlei G. Marques ◽  
...  
Keyword(s):  
Internal Transcribed Spacer ◽  
Novel Species ◽  
Large Subunit ◽  
Fatal Case ◽  
Content Type ◽  
History Of ◽  
Brain Abscesses ◽  
The Right ◽  
The Brain ◽  
Novel Agent

We report a fatal case of a chromoblastomycosis-like infection caused by a novel species ofFonsecaeain a 52-year-old immunocompetent Caucasian male from an area of chromoblastomycosis endemicity in Brazil. The patient had a 30-year history of slowly evolving, verrucous lesions on the right upper arm which gradually affected the entire arm, the left hemifacial area, and the nose. Subsequent dissemination to the brain was observed, which led to death of the patient. The internal transcribed spacer (ITS) and partial large subunit (LSU),BT2, andCDC42genes of the isolates recovered from skin and brain were sequenced, confirming the novelty of the species. The species is clinically unique in causing brain abscesses secondary to chromoblastomycosis lesions despite the apparent intact immunity of the patient. Histopathologic appearances were very different, showing muriform cells in skin and hyphae in brain.

Cerebral cellular response to profound hypothermia

1993 ◽  
Vol 3 (4) ◽  
pp. 383-393 ◽  
Author(s):  
Takao Watanabe ◽  
Masahiko Washio
Keyword(s):  
Carbon Dioxide ◽  
Cellular Response ◽  
Cerebral Metabolism ◽  
Circulatory Arrest ◽  
Low Flow ◽  
Profound Hypothermia ◽  
Flow Perfusion ◽  
Core Cooling ◽  
The Brain ◽  
Brain Tissues

AbstractIn our first two experiments, we examined brain tissue pH and tensions of oxygen and carbon dioxide in dogs core cooled to 20°C. So as to evaluate the effects of 60 minutes of circulatory arrest, 120 minutes of low-flow perfusion (25 mI/kg/mm), and 120 minutes of moderate-flow perfusion (50 mi/kg/mm), all conducted with and without pulsatile assistance. We further determined the effects of blood gas strategy on the same variables with 60 minutes of circulatory arrest. In a third experiment, we directly observed microcirculation at the surface of the brain during profoundly hypothermic perfusion. In the fourth experiment, we measured cerebral blood flow, oxygen consumption, and excessive production of lactate. Profound anoxia occurred within 20 minutes of circulatory arrest, causing severe and progressive acidosis in the brain tissues along with hypercapnia. The inhalation of 5% or 7% carbon dioxide during core cooling made the brain unacceptably acidotic. The brain acidosis was mild with low flow perfusion, and slight with moderate-flow perfusion. Pulsatile assistance improved acidosis in the brain tissues at all rates of flow. It also improved the microcirculation, the patent number of arterioles and stabilized flow in bridging veins. Cerebral metabolism became aerobic without alterations in cerebral consumption of oxygen during low-flow perfusion. We recommend flow rates above 25% of normal, alpha-stat strategy, and pulsatile assistance for better protection of the brain during profound hypothermia.

Effects of profound hypothermia and circulatory arrest on cerebral oxygen metabolism and cerebrospinal fluid electrolyte composition in dogs

1974 ◽  
Vol 40 (2) ◽  
pp. 199-205 ◽  
Author(s):  
Edgar A. Bering
Keyword(s):  
Brain Temperature ◽  
Circulatory Arrest ◽  
Oxygen Metabolism ◽  
Cerebral Oxygen ◽  
Profound Hypothermia ◽  
Content Type ◽  
Cerebral Oxygen Metabolism ◽  
Natural Logarithm ◽  
K Concentration ◽  
Fine Print

✓ Cerebral oxygen metabolism was studied in the dog at brain temperatures ranging from 37° to 8°C. As brain temperature decreased, the cerebral oxygen metabolism (CMRO2) decreased following the Arrhenius equation. The natural logarithm of the CMRO2 was a linear function of the reciprocal of the absolute (K) brain temperature. Oxygen metabolism, although much decreased, continued at very low brain temperatures. The CSF composition was unchanged after 1 hour at brain temperatures down to 10°C. Circulatory arrest for tolerable periods and longer caused changes only in the CSF potassium concentration. The interval between the onset of circulatory arrest and the beginning of the CSF K concentration increased with decreasing temperature and the rate of CSF K increase was increasingly slower at lower temperatures. At all temperatures the rate of CSF K changed gradually increased with time. The interval before the CSF K started to increase was dependent upon the amount of O2 available in the brain and the length of this interval was inversely proportional to the CMRO2. The amount of CSF K concentration was not clearly related to the tolerable periods of circulatory arrest, but at normal temperatures an obviously increased CSF K following a period of acute cerebral anoxia without CSF hemorrhage may indicate brain damage.

Primary osteogenic sarcoma of the brain

1976 ◽  
Vol 44 (1) ◽  
pp. 92-95 ◽  
Author(s):  
Skip Jacques ◽  
Donald B. Freshwater ◽  
C. Hunter Shelden
Keyword(s):  
Primary Tumor ◽  
Osteogenic Sarcoma ◽  
Mesenchymal Cell ◽  
Bone Scanning ◽  
Content Type ◽  
Autopsy Findings ◽  
Tumor Focus ◽  
The Right ◽  
The Brain ◽  
Fine Print

✓ The authors report a case of primary osteogenic sarcoma of the brain. Negative autopsy findings, complete bone radiographs, and bone-scanning techniques were consistent with a primary tumor focus in the right temporoparietal region of the brain. The authors suggest an origin from a primitive multipotential mesenchymal cell.

Sign in / Sign up

Export Citation Format

Share Document