Giant intracranial aneurysms pose significant technical problems for the neurosurgical team. Because of the location and structure of these lesions, the risks associated with traditional surgical techniques are usually unacceptable. Although aneurysm clipping using deep hypothermic circulatory arrest was first described 30 years ago, it was nearly abandoned because of poor outcomes associated with the systemic and cardiac complications of extracorporeal circulation. Advances in cardiopulmonary bypass techniques have inspired renewed interest in the use of this method in surgery for intracranial aneurysm. Deep hypothermic circulatory arrest, using low-flow states, has yielded exceptional patient outcomes. This increasingly popular means of management provides unique challenges to the neurosurgical health care team. Understanding the pre-, intra-, and postoperative care of these patients is imperative for neurosurgical nurses of the twenty-first century

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