Reappraisal of cardiopulmonary bypass with deep hypothermia and circulatory arrest for complex neurosurgical operations.

Although cardiopulmonary bypass (CPB) with hypothermia and circulatory arrest is routinely used for certain cardiovascular procedures, its advantages have infrequently been applied for other unusual surgical problems. Fourteen patients (six men and eight women, average age 48 years, range 29 to 74 years) underwent 15 operations over a 4-year period beginning in November 1978. Preoperative diagnosis included giant middle cerebral aneurysm (n = 8), internal carotid aneurysm (3), basilar artery aneurysm (2), and medullary hemangioblastoma (2). All patients had lesions that were considered inoperable by standard neurosurgical techniques. Operative technique consisted of peripheral cannulation with a long and short femoral vein cannula for venous return (24 to 28F) and a single femoral arterial cannula (18 to 24F). CPB flows ranged from 1 to 3.5 L/min, and the total CBP times averaged 146 minutes (range 66 to 282 minutes). Circulatory arrest times averaged 21 minutes (range 5 to 51 minutes), with two patients having no period of circulatory arrest. Lowest core temperature ranged from 16 degrees to 20 degrees C, with cooling and rewarming aided by Brown-Harrison heat exchangers placed in a countercurrent fashion within the venous return line. The heart spontaneously defibrillated in six patients, and external countershock was required in nine patients. No difficulty was encountered with cardiac distention. The intended operation was accomplished in all cases with 13 of 14 patients being discharged from hospital, having had a good neurosurgical result. One patient sustained a hemorrhagic infarction of the cerebellum and pons and is presently recovering. Our experience indicates that peripheral CPB with induced hypothermia and circulatory arrest is a safe technique for approaching otherwise inoperable neurosurgical lesions.