Extracorporeal circuit design considerations for giant intracranial aneurysm repair.

Clinical perfusionists must be able to modify the existing extracorporeal circuit in order to accommodate a specific surgical pathology. The clipping of a giant intracranial middle cerebral artery aneurysm, unapproachable with conventional neurosurgical techniques, required the use of a modified closed cardiopulmonary bypass circuit combined with deep hypothermia and total circulatory arrest. In-hospital discussions with anaesthesia, cardiac surgery, neurosurgery, and cardiology enabled an informed team approach directed towards the successful treatment of this complex neurosurgical lesion.