Rapid ventricular pacing for flow arrest during cerebrovascular surgery : revival of an old concept
Faculty of Medicine and Health Sciences
Neurosurgery. - Baltimore, Md, 1977, currens
, p. 270-275
University of Antwerp
Background: Intraoperative rupture of a cerebral aneurysm can be a devastating event that increases operative morbidity and mortality. Rapid ventricular pacing (RVP) is a technique used in interventional cardiology to obtain flow arrest for short periods of time. Objective: We present our experience of RVP for flow arrest during cerebrovascular surgery. Methods: RVP was employed to produce flow arrest for periods of 40 s in twelve patients who underwent craniotomy for a cerebrovascular disorder (11 aneurysms and 1 AVM). Results: DuringRVP there was an immediate and significant reduction of blood pressure in each patient. The maximum degree of hypotension was obtained 3.2 +/- 0.7 seconds (mean+/-SD) after start of RVP. When RVP was terminated, normal sinus rhythm returned instantaneously along with recovery of indices of hemodynamic function. Subjectively, the decrease in blood pressures facilitated dissection, and during clipping the aneurysm sac felt softer and was easier to manipulate. No complications related to RVP occurred. Conclusion: RVP during cerebrovascular surgery is an effective method for lowering the arterial blood pressure in a controlled and directly reversible manner. Advances in cardiology now make RVP a promising and safe technique that can facilitate complex cerebrovascular surgery.