Zh Vopr Neirokhir Im N N Burdenko. 2026;90(4):75-86. doi: 10.17116/neiro20269004175.
ABSTRACT
BACKGROUND: Despite advances in endovascular technologies, microsurgical clipping is still a relevant treatment for cerebral aneurysms. Blood flow reduction techniques become necessary in some cases (no adequate proximal and distal blood flow control). Rapid ventricular pacing is a new effective technique for controllable hypotension and aneurysm sac relaxation.
OBJECTIVE: To demonstrate successful rapid ventricular pacing in microsurgical clipping of a large aneurysm of vertebrobasilar confluence in acute period of SAH.
MATERIAL AND METHODS: A 64-year-old patient with SAH from vertebrobasilar confluence aneurysm underwent successful microsurgical treatment.
The patient underwent surgery on the second day after hemorrhage. Surgery was performed through a right-sided retrosigmoid approach. Two episodes of rapid ventricular pacing were used to relax the aneurysm and reduce the risk of intraoperative rupture. The effect was achieved almost immediately after initiation with episodes lasting no more than 50 seconds. Controllable hypotension minimized bleeding. There were no postoperative neurological complications. CT angiography showed complete exclusion of aneurysm. The patient was discharged after 10 postoperative days.
CONCLUSION: Rapid ventricular pacing may be justified in the treatment of complex cerebral aneurysms when surgical blood flow control is difficult. Large-scale studies are needed to develop patient selection algorithms for this surgery.
PMID:42565697 | DOI:10.17116/neiro20269004175