Emergency Neurosurgery in a Patient with a Large Thoracic Aortic Aneurysm: Sitting on a Bomb

Abstract

Thoracic aortic aneurysms larger than 5 cm are associated with a fatal risk of rupture, and their diagnosis is usually followed by urgent surgical repair. Other complications associated with this condition include heart failure, myocardial infarction, and stroke. Literature regarding management of these patients for emergency noncardiac surgeries is scarce, with anecdotal reports advising both surgeries in the same sitting. However, neurosurgical procedures present a unique challenge in this situation, since systemic anticoagulation may be associated with a rebleed within the cranial vault. In this case report, we present an extremely rare and challenging scenario, wherein a patient with a 6.2-cm thoracic aortic aneurysm underwent subdural hematoma evacuation prior to aneurysmal repair.

Keywords

anesthesia - aortic aneurysm - emergency neurosurgery - subdural hematoma

Publikationsverlauf

Artikel online veröffentlicht:
24. April 2023

• References

• 1 Mathur A, Mohan V, Ameta D, Gaurav B, Haranahalli P. Aortic aneurysm. J Transl Int Med 2016; 4 (01) 35-41
• 2 Wang TKM, Desai MY. Thoracic aortic aneurysm: optimal surveillance and treatment. Cleve Clin J Med 2020; 87 (09) 557-568
• 3 Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation 2005; 111 (06) 816-828
• 4 JCS Joint Working Group. Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection (JCS 2011): digest version. Circ J 2013; 77 (03) 789-828
• 5 Cheng K-W, Chen C-L, Wang C-S. et al. Anesthesia management in a patient with an abdominal aortic aneurysm undergoing liver transplantation: a case report. Transplant Proc 2008; 40 (08) 2830-2831
• 6 Wasnick JD, Hillel Z, Kramer D, Littwin S, Nicoara A. . Chapter 9. Anesthesia for Repair of Diseases of Thoracic Aorta [Internet]. In: Cardiac Anesthesia and Transesophageal Echocardiography. New York, NY: The McGraw-Hill Companies; 2011
• 7 Verzar Z, Szabados S. Anesthetic Management of Aortic Aneurysm. In: Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms [Internet]. September 12, 2011; Available at: http://dx.doi.org/10.5772/17451
• 8 Hiratzka LF, Bakris GL, Beckman JA. et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121 (13) e266-e369
• 9 Erbel R, Aboyans V, Boileau C. et al; ESC Committee for Practice Guidelines; The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J 2014; 35 (41) 2873-2926
• 10 Gupta PK, Gupta H, Khoynezhad A. Hypertensive emergency in aortic dissection and thoracic aortic aneurysm-a review of management. Pharmaceuticals (Basel) 2009; 2 (03) 66-76
• 11 Giumelli C, Vazzana N, Bianchi A, Chesi G. Chronic cough revealing a giant thoraco-abdominal aortic aneurysm. Vasc Med 2016; 21 (03) 274-275
• 12 Miller CP, Firoozan S, Woo EK, Apps A. Chronic cough: a herald symptom of thoracic aortic aneurysm in a patient with a bicuspid aortic valve. BMJ Case Rep 2014; 2014: bcr2014205005-bcr2014205005
• 13 Türköz A, Gülcan O, Tercan F, Koçum T, Türköz R. Hemodynamic collapse caused by a large unruptured aneurysm of the ascending aorta in an 18 year old. Anesth Analg 2006; 102 (04) 1040-1042
• 14 Sugimoto T, Ogawa K, Asada T, Mukohara N, Nishiwaki M. Severe hypoxia due to ventilation-perfusion mismatch caused by aortic arch aneurysm. Chest 1992; 102 (01) 322-323
• 15 Patil TA, Nierich A. Transesophageal echocardiography evaluation of the thoracic aorta. Ann Card Anaesth 2016; 19 (Supplement): S44-S55
• 16 Kertai MD, Boersma E, Westerhout CM. et al. A combination of statins and beta-blockers is independently associated with a reduction in the incidence of perioperative mortality and nonfatal myocardial infarction in patients undergoing abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg 2004; 28 (04) 343-352
• 17 Baptista A, Carvalho S, Magalhães P, Carneiro M, Mateus P, Moreira I. Mural thrombus and thoracic aortic aneurysm: an unusual association [in Portuguese]. Rev Port Cardiol 2014; 33 (06) 393-394