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Review
Adenosine to facilitate the clipping of cerebral aneurysms: literature review
  1. Virendra R Desai1,
  2. Alejandro L Rosas2,
  3. Gavin W Britz1
  1. 1 Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
  2. 2 Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, Texas, USA
  1. Correspondence to Dr Gavin W Britz; gbritz{at}houstonmethodist.org

Abstract

Cerebral aneurysms have a high mortality rate when ruptured. Endovascular techniques have improved substantially in treating this pathology. However, surgical clip ligation remains the preferred option for some aneurysms. Various techniques are used intraoperatively to assist the surgeon in dissecting the aneurysmal dome free of surrounding tissue and placing a clip around the neck safely and effectively so that no nearby perforating vessels are affected and no residual remains. These techniques include temporary clip ligation, endovascular balloon occlusion and cardiac standstill. Adenosine use is one viable option for induced cardiac arrest leading to a short period of controlled hypotension. Its predictable course of action, rapid onset and offset and rare incidence of adverse side effects make it an attractive agent in this regard. Below, we provide an introduction to adenosine use, describing its pharmacokinetic properties, indications, contraindications, complications and future directions.

  • Adenosine
  • cerebral aneurysm
  • aneurysmal clip ligation
  • induced hypotension

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/svn-2017-000082

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    Footnotes

    • Contributors VRD, ALR and GWB contributed significantly to this work, including the concept and design of the project and the drafting, revising and final approval. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Disclaimer The views expressed within this article are those of the authors alone and not an official position of the institution Houston Methodist Hospital.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.