• Vera Saldien, Tomas Menovsky, Margo Rommens, Gregory Van der Steen, Katrin Van Loock, Gaelle Vermeersch, Chris Mott, Johan Bosmans, Dirk De Ridder, and Andrew I R Maas.
• Department of Anesthesiology, Antwerp University Hospital, Edegem, Belgium.
• Neurosurgery. 2012 Jun 1;70(2 Suppl Operative):270-5.

BackgroundIntraoperative 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.ObjectiveTo present our experience using RVP for flow arrest during cerebrovascular surgery.MethodsWe used RVP to produce flow arrest for periods of 40 seconds in 12 patients who underwent craniotomy for a cerebrovascular disorder (11 aneurysms and 1 arteriovenous malformation).ResultsDuring RVP, 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 the start of RVP. When RVP was terminated, normal sinus rhythm returned instantaneously, along with recovery of indexes 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.ConclusionRapid ventricular pacing 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.

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