A 46-year-old male presented with a history of sudden severe headache 1 week back,
altered sensorium and right hemiparesis for 2 days. On examination, Glasgow Coma Scale
(GCS) was E4V4M6 and the patient had right hemiparesis (power – 4/5). Computed tomography
(CT) revealed diffuse subarachnoid hemorrhage (Fisher's Grade III). CT angiogram revealed
distal basilar trunk aneurysm arising between the origin of the left posterior cerebral
artery and superior cerebellar artery, ectatic dilatation of distal basilar trunk,
and a left middle cerebral artery (MCA) bifurcation aneurysm. Basilar trunk aneurysm
was approached through subtemporal route and aneurysm was clipped during adenosine-induced
profound hypotension (AIPH) without application of temporary clip. Single bolus 6
mg of adenosine was given, and aneurysm was successfully clipped during AIPH (systolic
<60 mmHg). There were no complications related to adenosine. Ectatic part of distal
basilar trunk was wrapped with Teflon. The left MCA bifurcation aneurysm was clipped
in the same session. At 3-month follow-up, the patient's sensorium was normal (GCS-E4V5M6)
and the right hemiparesis improved (4+/5). Adenosine enhances the safety of clipping
these aneurysms by providing transient cardiac arrest or profound hypotension. In
developing countries, microsurgical clipping is a cost-effective treatment option
for basilar artery aneurysms.
Key-words:
Adenosine-induced asystole - adenosine-induced profound hypotension - basilar artery
aneurysm - basilar trunk aneurysm - clipping - middle cerebral artery bifurcation
aneurysm - multiple intracranial aneurysms
