HEMODYNAMIC OPTIMIZATION IN CEREBRAL ANEURYSM SURGERY WITH LUMBAR DRAINAGE: A CASE REPORT

Management of complex cerebral aneurysms requiring a superficial temporal artery-middle cerebral artery (STA-MCA) bypass demands triphasic hemodynamic stabilization (pre-clipping, during temporary clipping, and post-revascularization) to maintain adequate cerebral perfusion pressure and prevent complications such as rupture and perioperative ischemia. A 48-year-old woman with a history of hypertension and subarachnoid hemorrhage (Modified Fisher Grade 4) underwent right MCA aneurysm clipping with STA-MCA bypass accompanied by lumbar drainage to achieve optimal brain relaxation and perfusion stability. Throughout the procedure, a TIVA approach using propofol and dexmedetomidine enabled tight control of blood pressure, normocapnia, and anesthetic depth across all critical phases, including during temporary M1-M2 clipping. Postoperative outcomes demonstrated stable hemodynamics, early extubation, absence of new neurological deficits, and no evidence of delayed cerebral ischemia based on clinical and hemodynamic monitoring in the ICU. This case highlights that integrating phase-specific hemodynamic strategies, controlled lumbar drainage, and consistent TIVA administration forms an effective combination to optimize cerebral perfusion and prevent major complications in complex neurovascular procedures such as aneurysm clipping with bypass.