Introduction: Aneurysms of the para-ophthalmic segment of anterior circulation are common. Their treatment are challenging because of the narrow anatomic corridor of the internal carotid artery for proximal control. Rapid ventricular pacing (RVC) is one of the methods to control blood flow during dissection and clip application. The present study aimed to asses the efficacy of RVC as proximal control in para-ophthalmic aneurysms.
Methods: Three patients have been enrolled in this study until now. RVC was used during the aneurysm dissection and clip application in all cases.
Results: The RVC was feasible to use during the procedures. It was used frequently > 5 times in one of the cases for up to 2 minutes duration using continuous ECG monitoring with uneventful recovery of all patients.
Conclusions: The RVC is save and convenient to use during para-Opthalmic aneurysms surgery and should be considered as standard method for proximal control.
Patient Care: It will add a safe and convenient method of proximal control in para-ophthalmic aneurysm that will help to improve the surgical outcome of these diseases.
Learning Objectives: 1- Study the anatomy of internal carotid artery and different blood inflow to para-ophthalmic aneurysm.
2- Review different methods of proximal control in para-ophthalmic artery aneurysms.
3- Study the efficacy and safety of RVC use in para-Opthalmic aneurysms.
References: 1- Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report,
J Neurosurg Pediatr. 2015 Jun;15(6):625-9. doi: 10.3171/2014.11.PEDS14290. Epub 2015 Mar 6.
Nimjee SM1,2, Smith TP1, Kanter RJ3, Ames W4, Machovec KA4, Grant GA2, Zomorodi AR2.
2- Update on transient cardiac standstill in cerebrovascular surgery:
Neurosurg Rev. 2015 Oct;38(4):595-602. doi: 10.1007/s10143-015-0637-z. Epub 2015 May 1.
Rangel-Castilla L1, Russin JJ, Britz GW, Spetzler RF.
3- Rapid ventricular pacing: a novel technique to decrease cardiac output for giant basilar aneurysm surgery:
J Clin Anesth. 2012 Dec;24(8):656-8. doi: 10.1016/j.jclinane.2012.04.013.
Whiteley JR1, Payne R, Rodriguez-Diaz C, Ellegala DB, Reeves ST.
4- Acute decrease of cerebral oxygen saturation during rapid ventricular and supraventricular rhythm: a pilot study:
Clin Electrophysiol. 2014 Sep;37(9):1159-65. doi: 10.1111/pace.12424. Epub 2014 May 16,
Wutzler A1, Otto N, Gräser S, Boldt LH, Huemer M, Parwani A, Haverkamp W, Storm C.
5-Rapid ventricular pacing for flow arrest during cerebrovascular surgery: revival of an old concept:
Neurosurgery. 2012 Jun;70(2 Suppl Operative):270-5. doi: 10.1227/NEU.0b013e318236d84a,
Saldien V1, Menovsky T, Rommens M, Van der Steen G, Van Loock K, Vermeersch G, Mott C, Bosmans J, De Ridder D, Maas AI.