Intentional clinical death: managing aneurysms I Lara B

Surgical management of giant cerebral aneurysms remains a major technical challenge for modern neurosurgeons. They form at thinning artery walls, so aneurysms are often found at forks or branches in arteries - as those sections of the vessel are weaker.

Although giant cerebral aneurysms can appear anywhere in the brain, they are most common in arteries at the base. This means removal of the aneurysm poses a large threat as to the intricate network of arteries and blood vessels it inhabits due to the risk of major blood loss and brain damage.

This can be a great risk to the patient at hand, as the aneurysm can be ruptured by stress or anxiety, and are not easily removed. However, there are procedures that offer a solution to the famously tedious and stressful technical procedure of removing the aneurysm.

^ CT (computerised tomography) of the brain, containing an aneurysm.

A way these aneurysms can be removed is by ‘deep hypothermic circulatory arrest' (DHCA), a complex surgery that involves inducing deep medical hypothermia and stopping brain function and blood circulation for about an hour. In other words, legally killing the patient and bringing them back to life. It is used when blood circulation to the brain must be stopped because of delicate surgery within it, or because of intricate surgery (on large blood vessels) that lead to or from the brain.

The most important part of the surgery is the stopping of the blood circulation, as it provides a better visual field during surgery due to the cessation of blood flow. Of course, the procedure itself can be incredibly risky, so most procedures involve a time limit - so there is no room for error.

While hypothermia is the main method of protecting the brain, other neuroprotective strategies include pharmacological methods and glucose control. Essentially, DHCA is not the only method of removing giant cerebral aneurysms.

For many, DHCAs are a viable alternative to the other methods of treatments, yet to recognise the aneurysm first, certain assessments must be made. An MRI or CT scan is usually used to look for aneurysms in the brain that haven't ruptured. This type of scan uses strong magnetic fields and radio waves to produce detailed images of your brain.. A lumbar puncture is a procedure where a needle is inserted into the lower part of the spine to remove a sample of the fluid that surrounds and supports the brain and spinal cord. This fluid can be analyzed for signs of bleeding, as it will contain red blood cells that are not usually there.

Once a diagnosis and treatment have been administered to get rid of the aneurysm, the only next step is prevention. You can reduce the risk of developing an aneurysm by not smoking and reducing high blood pressure.

References

Wikipedia Contributors (2021). Standstill. [online] Wikipedia. Available at: https://en.wikipedia.org/wiki/Standstill [Accessed 22 Dec. 2021].

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Wikipedia Contributors (2021). Deep hypothermic circulatory arrest. [online] Wikipedia. Available at: https://en.wikipedia.org/wiki/Deep_hypothermic_circulatory_arrest [Accessed 11 Jan. 2022].

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