Oregon Brain Preservation
A Non-profit Organization

Manual - Surgical Procedures

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Cannulation of Carotid Arteries

This entire procedure, from initial incision to the beginning of washout, can be done reliably and safely in under one minute. If the procedure must be delayed, apply ice packs, cephalic ice bath, or nasopharyngeal irrigation to the head, depending on the situation.  Do not perform CPR.


Place body in supine position on a flat table. Slide the backboard and cephalic isolator under the head and shoulders.  Slide the body in a superior direction until the neck is in hyperextension.  Make the initial incision across the superior edge of the sternum and clavicles with a #22 blade.  Apply pressure to the chin to cause further hyperextension of the neck as the incision deepens.  Keeping the incision near the clavicles, make repeated cuts until both common carotid arteries are transected. Apply hemostats to vessels on the trunk, as necessary, to maintain a clean field.


To cannulate an artery, grasp both walls of the artery with cotton forceps.  Use fingers to pull the fascia down the artery, away from the forceps, until 3 cm is clear.  A 4.5 mm Cannula will already be connected to the tubing, debubbled, and pumping with low flow.  A nylon tie will be in place loosely on the tubing.   Grasp the lateral wall of the artery with the cotton forceps in the left hand.  While holding both the cannula and the artery at a 45 degree angle to prevent air entrapment, insert the cannula.  Slide the nylon tie down onto the artery, and tighten to secure.  Tug the cannula to verify placement and security.  Washout is now under way with low flow.  Cannulate the contralateral common carotid artery in the same manner.  If there is any leakage at either cannula, apply a second nylon tie or a loop of umbilical tape. 


Once washout is under way on both arteries, use a surgical hand saw to cut through the vertebral column.  Complete the cephalic isolation with a scalpel.  Look for effluent coming from the vertebral arteries.  If there is effluent, then attempt to clamp the vertebral arteries.  If there is no effluent, it may be due to an embolism.  Alternatively, this could be one of the 6% of patients who have an incomplete circle of Willis.  If an incomplete circle is suspected, then attempt to cannulate and perfuse the vertebral arteries with needle cannulae.


Pet Thoracotomy

Using rib shears, cut through the full thickness of skin and ribs vertically on both sides of the sternum.  Remove the sternum and attached tissue.  The shape of the cut and the instruments used will depend on the size and species of the animal.  The clavicles are typically cut as well.  Apply a sternal retractor. Dissect out the brachiocephalic trunk, which has a different standard anatomy from that of humans.  The first two branches of the brachiocephalic trunk are the left and right common carotid arteries, and then it continues as the right subclavian artery.  Cannulate the brachiocephalic trunk near the heart.


Removal of Brain

(description of procedure to follow later)


Brain Case Isolation

(description of procedure to follow later)


Pet Removal of Brain

(description of procedure to follow later)