Endovascular selective hypothermia facilitates giant aneurysm clipping: illustrative case

Thomas K Mattingly; Pablo Lopez-Ojeda; Miguel Arango; Chris Harle; Nirmal Kakani; Peter Allen; Barbara Lehrbass; Stephen P Lownie

doi:10.3171/CASE2090

Endovascular selective hypothermia facilitates giant aneurysm clipping: illustrative case

J Neurosurg Case Lessons. 2021 Feb 15;1(7):CASE2090. doi: 10.3171/CASE2090.

Authors

Thomas K Mattingly^{1

2}, Pablo Lopez-Ojeda¹, Miguel Arango³, Chris Harle³, Nirmal Kakani⁴, Peter Allen⁵, Barbara Lehrbass⁴, Stephen P Lownie^{1

4}

Affiliations

¹ Departments of Neurosurgery.
² Department of Neurosurgery, University of Rochester, Rochester, New York.
³ Anesthesiology.
⁴ Imaging Sciences, and.
⁵ Cardiac Surgery, Western University, London, Ontario, Canada; and.

Abstract

Background: The authors present a case of selective hypothermia used for neuroprotection during clipping of a giant partially thrombosed middle cerebral artery (MCA) aneurysm. Although these cases have traditionally required deep hypothermic cardiac arrest, this case illustrates a novel and entirely endovascular solution that avoids cardiac standstill and whole-body cooling.

Observations: This is, to the authors' knowledge, the first case in human surgery of a catheter-based selective hypothermic circuit used to facilitate MCA trapping for almost 30 minutes. Core temperatures never dropped below 34°C, and the patient recovered uneventfully and has been well for over 5 years.

Lessons: The technical nuances and physiological changes unique to selective hypothermia are discussed.

Keywords: ACT = activated clotting time; CCA = common carotid artery; IFL = inner flow lumen; MCA = middle cerebral artery; MRI = magnetic resonance imaging; OFL = outer flow lumen; endovascular; giant aneurysm; hypothermia.

Publication types

Case Reports