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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Prospective evaluation of rapid ventricular pacing in microsurgical clip-reconstruction of complex unruptured intracranial aneurysms

Meeting Abstract

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  • Johannes Platz - Klinik für Neurochirugie, Universitätsklinikum der Goethe-Universität Frankfurt, Frankfurt am Main, Germany
  • Jürgen Konczalla - Klinik für Neurochirugie, Universitätsklinikum der Goethe-Universität Frankfurt, Frankfurt am Main, Germany
  • Stephan Fichtlscherer - Klinik für Kardiologie, Universitätsklinikum der Goethe-Universität Frankfurt, Frankfurt am Main, Germany
  • Haitham Mutlak - Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum der Goethe-Universität Frankfurt, Frankfurt am Main, Germany
  • Ulrich Strouhal - Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum der Goethe-Universität Frankfurt, Frankfurt am Main, Germany
  • Volker Seifert - Klinik für Neurochirugie, Universitätsklinikum der Goethe-Universität Frankfurt, Frankfurt am Main, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.09.07

doi: 10.3205/16dgnc150, urn:nbn:de:0183-16dgnc1508

Published: June 8, 2016

© 2016 Platz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Treatment of complex unruptured intracranial aneurysms (UIA) remains challenging to date. Therefore, advanced techniques are required to achieve an optimal result in treating these patients safely. In this study, the safety and efficacy of rapid ventricular pacing (RVP) to facilitate microsurgical clip-reconstruction has been studied prospectively.

Method: Patients with complex UIA were prospectively enrolled and the safety and efficacy of RVP were evaluated recording cardiovascular events, new DWI-lesions on post-operative MRI, and outcome of the patients. Furthermore, aneurysm occlusion after the procedure was documented.

Results: Seventeen patients (mean 53.5 ± 7.4 years) were included in this study and RVP was applied in 14 patients although technical failure prevented its use in one patient. Mean aneurysm size was 10.9 ± 5.6 mm. In the 13 patients who underwent successful RVP, RVP proved to be a very helpful tool in clip-application and aneurysm-preparation intraoperatively. RVP was used 1.7 times (mean) per patient with a duration of 65 ± 28 sec reducing the mean arterial pressure (MAP) to 50 ± 7.6 mmHg. This lead to softening of the aneurysmal sac facilitating its mobilization, clip-application and closure of the blades. In two patients, cardiac events were documented which resolved without permanent sequelae in both. New DWI-lesions were documented in 6 patients (43%). Of those, an embolic pattern was noted in 3 patients. While the aneurysm in the patient in whom RVP did not work could not be clipped safely, total or near total aneurysm occlusion was documented in 12 patients (86%). Outcome according to mRS was favorable in all patients.

Conclusions: RVP is an elegant technique that facilitates clip-reconstruction in complex UIA. The safety of the procedure is high. Yet, as extensive preoperative work-up of the patient and an experienced neuro-anesthesiologist team are required, it remains reserved for selected elective cases and highly specialized centers, only.