Intraoperative hypothermia during vascular neurosurgical procedures. Neurosurg Focus 26:E24
Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305-5327, USA. Neurosurgical FOCUS
(Impact Factor: 2.11).
06/2009; 26(5):E24. DOI: 10.3171/2009.3.FOCUS0927
Increasing evidence in animal models and clinical trials for stroke, hypoxic encephalopathy for children, and traumatic brain injury have shown that mild hypothermia may attenuate ischemic damage and improve neurological outcome. However, it is less clear if mild intraoperative hypothermia during vascular neurosurgical procedures results in improved outcomes for patients. This review examines the scientific evidence behind hypothermia as a treatment and discusses factors that may be important for the use of this adjuvant technique, including cooling temperature, duration of hypothermia, and rate of rewarming.
Available from: Ravi Dadlani
- "This paper addresses the risks associated with primary clipping of aneurysms larger than 2 cm, located in the anterior circulation. The use of microsurgical, endovascular modalities and adjuncts like intra-operative neuromonitoring and blood-flow studies provide a multi-modality approach to treat this complex pathology  . "
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Aneurysms of the anterior circulation larger than 2cm have a complex relationship to the anterior skull base, requiring a multi-modality management approach. This retrospective study of 54 patients with such aneurysms who underwent clipping between 2001 and 2012 analyzes clinical and surgical data, aneurysm characteristics and correlates them with respect to the Glasgow outcome score at follow-up and immediate post-operative clinical status.
Patients with an outcome score of 5 or 4 were categorized as "good", while those with score 3-1 were "poor". Fisher's exact test and paired T-test (p<0.5) were used to test statistical significance for discrete and continuous variables respectively.
44 (81.4%) patients had a good outcome. Patients with non-ophthalmic/paraclinoid aneurysms had significantly lower incidence of adverse intra-operative events (p=0.035). Patients older than 50 years (p=0.045), with adverse intra-operative events (p=0.015) and post-operative infarction (p<0.001) had a poor outcome compared to those younger than 50 years age and those without adverse intra-operative events or infarctions. The grouped age variable had maximum influence on patient outcome. Location and size of aneurysm did not have an overall impact on surgical outcome. There were 4 mortalities.
Primary clipping of proximal non-cavernous aneurysms on the internal carotid artery is associated with adverse intra-operative events. A multi-modality treatment approach in these aneurysms should be individualized, more so in patients older than 50 years.
Clinical Neurology and Neurosurgery 07/2014; 122C:42-49. DOI:10.1016/j.clineuro.2014.04.012 · 1.13 Impact Factor
Available from: Bruno P Meloni
- "It is worth considering here the use of hypothermia during (when it is most effective) cardiothoracic and neurosurgical procedures, in which body temperatures are lowered from anywhere from 26 -35°C, specifically to protect tissues, including the brain, during an anticipated period of compromised blood supply. For example during cardiac surgery, there are two distinct levels of hypothermia that are commonly used; a target body temperature of 34 -35ºC is now becoming accepted as the standard for Cardiopulmonary Bypass (CPB), while in especially critical cases surgeons may opt to use Deep Hypothermic Circulatory Arrest (DHCA) in which patients are cooled to a rather extreme 15 -26ºC (Choi et al., 2009; Cook, 2009; Mackensen et al., 2009). "
Advances in the Treatment of Ischemic Stroke, 03/2012; , ISBN: 978-953-51-0136-9
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ABSTRACT: A small reduction of body temperature during reperfusion following cerebral ischemia has been known to ameliorate neuronal injury. However, the mechanisms underlying postischemic hypothermia-induced neuroprotection are poorly understood. The burst of reactive oxygen species (ROS) formation that occurs during reperfusion has been documented to be involved in ischemic neuronal degeneration. In this study, we investigated the effect of postischemic hypothermia on ROS production following transient forebrain ischemia using an in vivo microdialysis technique. Forebrain ischemia was induced by bilateral carotid artery occlusion combined with hemorrhagic hypotension for 20 min in male Wistar rats. The body temperature was kept at 37 degrees C during ischemia and controlled at either 32 degrees C or 37 degrees C after reperfusion. The amount of hydroxyl radical produced in striatum was evaluated by measurement of 2,3- and 2,5-dihydroxybenzoic acid (DHBA), which is generated by salicylate hydroxylation. We also measured the extracellular concentration of xanthine, while determining striatal blood flow by the hydrogen clearance technique. In animals whose postischemic body temperature was maintained at 37 degrees C, the levels of 2,3- and 2,5-DHBA significantly increased after reperfusion. The peak levels of 2,3- and 2,5- DHBA were 2.9-fold and 2.7-fold increased above the corresponding baseline values, respectively. Postischemic hypothermia completely inhibited the hydroxyl radical formation. Likewise, xanthine formation was also inhibited by postischemic hypothermia. In contrast, striatal cerebral blood flow was not altered by temperature modulation during reperfusion. These results suggest that inhibition of ROS production accompanied with suppression of xanthine formation is implicated in the neuroprotection of postischemic hypothermia.
Journal of Neurotrauma 06/2003; 20(5):511-20. DOI:10.1089/089771503765355577 · 3.71 Impact Factor
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