Chapter title |
Adenosine-Assisted Clipping of Intracranial Aneurysms
|
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Book title |
Trends in the Management of Cerebrovascular Diseases
|
Published in |
Acta neurochirurgica Supplement, September 2018
|
DOI | 10.1007/978-3-319-73739-3_2 |
Pubmed ID | |
Book ISBNs |
978-3-31-973738-6, 978-3-31-973739-3
|
Authors |
Torstein R. Meling |
Abstract |
Temporary parent vessel clip occlusion in aneurysm surgery is not always practical or feasible. Adenosine-induced transient cardiac arrest may serve as an alternative. All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole performed by the author between September 2011 and July 2014 were retrospectively reviewed. A total of 16 craniotomies were performed and 16 aneurysms were clipped under adenosine-induced asystole (in 8 basilar arteries, 7 internal carotid arteries, and 1 middle cerebral artery) in 14 patients (8 females, 6 males). Seven cases were elective and 7 were performed after subarachnoid hemorrhage. The patients' mean age was 54 years (range, 39-70 years). The indications for adenosine use were proximal control in narrow surgical corridors in 11 cases, aneurysm softening in 4 cases, and aneurysm rupture in 1 case. A single dose was used in 12 patients; 2 patients had multiple boluses. The median (range) total dose was 30 (18-60) mg. Adenosine induced bradycardia with concomitant arterial hypotension in all patients and the majority also had asystole for 5-15 s. Transient cardiac arrhythmias were noted in 1 patient (atrial fibrillation in need of electroconversion after two boluses). Nine clinical scenarios were identified in which adenosine-induced temporary cardiac arrest and deep hypotension was an effective adjunct to temporary clipping during the microsurgical clipping of intracranial aneurysms. |
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Members of the public | 1 | 100% |
Mendeley readers
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Unknown | 21 | 100% |
Demographic breakdown
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Student > Postgraduate | 4 | 19% |
Other | 3 | 14% |
Researcher | 2 | 10% |
Student > Bachelor | 2 | 10% |
Librarian | 1 | 5% |
Other | 2 | 10% |
Unknown | 7 | 33% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 7 | 33% |
Neuroscience | 1 | 5% |
Materials Science | 1 | 5% |
Unknown | 12 | 57% |