J. Abdullah, WA Wan Adnan, S.Sharmax, AJ Nizar, A. Saedah, M. Maharowi.
Neurosurgical Division, Department of Anaesthesiology,
School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian,
Kelantan, Malaysia.
Complete circulatory arrest, hypothermia and barbiturate cerebral protection have been used in surgical treatment of basilar aneurysm in developed centers in the USA.
We report a case where deep barbiturate cerebral protection was given 12 hours before basilar artery aneurysm clipping. This patient was monitored preoperatively with a jugular oximeter system allows a transbasal approach with minimal traction to the left temporal lobe in a dominant area. The patient with a Hunt and Hess grade 4 eventually recovered with a Glasgow outcome score of 3/5.
Conclusion: Barbiturate coma may be used in difficult approaches to vascular lesions deep in the brain. Combination with hyperthermia and circulatory arrest can only be done in a center with cardiothoracic facilitates.
Reference:
1. Spetzler RF, Hadley MN, Rigamonti D
et al. Aneurysms of the basilar artery treated with circulatory arrest,
hypothermia and barbiturate cerebral protection.
2. Collice M, Arena O, D’Alibertic G et
al. Transbasal approaches to aneurysms of the vetebro basilar junction.
J. Neurosurg Sci 1998,42(1):81-6.
3. GreeneKA, Marciano FF, Hamilton MG
et al. Cardiopulmonary bypass hypothermia circulatory arrest and barbiturate
cerebral protection for the treatment of giant vetebrobasilar aneurysm
in children. Pediatr-Neurosurg 1994:21(2):124-33.