PDF herunterladen
CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(04): 1214-1217
DOI: 10.4103/ajns.AJNS_157_19
Case Report

Microsurgical clipping of distal basilar trunk aneurysm during adenosine-induced profound hypotension

Narayanam Sai Kiran
0   Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh
,
Veldurti Kiran Kumar
0   Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh
,
Valluri Kumar
1   Department of Neuroanaesthesia, Narayana Medical College Hospital, Nellore, Andhra Pradesh
,
Amit Agrawal
0   Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

A 46-year-old male presented with a history of sudden severe headache 1 week back, altered sensorium and right hemiparesis for 2 days. On examination, Glasgow Coma Scale (GCS) was E4V4M6 and the patient had right hemiparesis (power – 4/5). Computed tomography (CT) revealed diffuse subarachnoid hemorrhage (Fisher's Grade III). CT angiogram revealed distal basilar trunk aneurysm arising between the origin of the left posterior cerebral artery and superior cerebellar artery, ectatic dilatation of distal basilar trunk, and a left middle cerebral artery (MCA) bifurcation aneurysm. Basilar trunk aneurysm was approached through subtemporal route and aneurysm was clipped during adenosine-induced profound hypotension (AIPH) without application of temporary clip. Single bolus 6 mg of adenosine was given, and aneurysm was successfully clipped during AIPH (systolic <60 mmHg). There were no complications related to adenosine. Ectatic part of distal basilar trunk was wrapped with Teflon. The left MCA bifurcation aneurysm was clipped in the same session. At 3-month follow-up, the patient's sensorium was normal (GCS-E4V5M6) and the right hemiparesis improved (4+/5). Adenosine enhances the safety of clipping these aneurysms by providing transient cardiac arrest or profound hypotension. In developing countries, microsurgical clipping is a cost-effective treatment option for basilar artery aneurysms.

Key-words:

Adenosine-induced asystole - adenosine-induced profound hypotension - basilar artery aneurysm - basilar trunk aneurysm - clipping - middle cerebral artery bifurcation aneurysm - multiple intracranial aneurysms

Financial support and sponsorship

Nil.




Publikationsverlauf

Artikel online veröffentlicht:
09. September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Groff MW, Adams DC, Kahn RA, Kumbar UM, Yang BY, Bederson JB, et al. Adenosine-induced transient asystole for management of a basilar artery aneurysm. Case report. J Neurosurg 1999;91:687-90.
  • 2 Rangel-Castilla L, Russin JJ, Britz GW, Spetzler RF. Update on transient cardiac standstill in cerebrovascular surgery. Neurosurg Rev 2015;38:595-602.
  • 3 Al-Mousa A, Bose G, Hunt K, Toma AK. Adenosine-assisted neurovascular surgery: Initial case series and review of literature. Neurosurg Rev 2019;42:15-22.
  • 4 Bebawy JF, Gupta DK, Bendok BR, Hemmer LB, Zeeni C, Avram MJ, et al. Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation: Dose-response data and safety profile. Anesth Analg 2010;110:1406-11.
  • 5 Bendok BR, Gupta DK, Rahme RJ, Eddleman CS, Adel JG, Sherma AK, et al. Adenosine for temporary flow arrest during intracranial aneurysm surgery: A single-center retrospective review. Neurosurgery 2011;69:815-20.
  • 6 Powers CJ, Wright DR, McDonagh DL, Borel CO, Zomorodi AR, Britz GW, et al. Transient adenosine-induced asystole during the surgical treatment of anterior circulation cerebral aneurysms: Technical note. Neurosurgery 2010;67:461-70.
  • 7 Wang X, Feletti A, Tanaka R, Yamada Y, Suyama D, Kawase T, et al. Adenosine-induced flow arrest to facilitate intracranial complex aneurysm clip ligation: Review of the literature. Asian J Neurosurg 2018;13:539-45.
  • 8 Lee SH, Kwun BD, Kim JU, Choi JH, Ahn JS, Park W, et al. Adenosine-induced transient asystole during intracranial aneurysm surgery: Indications, dosing, efficacy, and risks. Acta Neurochir (Wien) 2015;157:1879-86.
  • 9 Tahir MZ, Enam SA, Ali RP, Bhatti A, ul Haq T. Cost-effectiveness of clipping vs. coiling of intracranial aneurysms after subarachnoid hemorrhage in a developing country a prospective study. Surg Neurol 2009;72:355-60.
  • 10 Heiskanen O. Risk of bleeding from unruptured aneurysm in cases with multiple intracranial aneurysms. J Neurosurg 1981;55:524-6.