title: Moderate hypothermia for intradural spinal tumor resection: a cohort comparison and feasibility study.
abstract: To evaluate the safety and feasibility of modest hypothermia as a potential strategy for intraoperative neuroprotection during the removal of intradural spinal tumors. A retrospective review was performed for two groups of patients of a single surgeon who underwent intradural extrameduallary and intramedullary spinal tumor resection of tumors located between cervical level 1 and lumbar 2 over a 10-year period between 2001 and 2010. One cohort received intraoperative moderate hypothermia (33°C) via intravascular catheter cooling during tumor surgery and the second cohort, a historical control group of the same surgeon, underwent surgery at normothermia (≥36°C). The main outcome measured was safety as determined by surgical, medical, and neurological complications. The hypothermia (n=38) and nonhypothermia (n=34) groups were homogenous for patient demographics and baseline comorbidities. There were no differences between the groups regarding tumor level (p=0.51), tumor pathology, or intramedullary versus intradural extramedullary location (p=0.11). The hypothermia group had a lower mean body temperature (33.7°C±0.72 vs. 36.6°C±0.7, p≤0.001) longer postoperative hospital stays (10.8±14.0 vs. 7.3±4.72, p<0.001), but there were no significant differences in operative and perioperative variables such as, total anesthetic time (8.2±2.4 vs. 7.8±2.7 hours, p=0.45), total surgical time (5.9±2.1 vs. 5.7±2.5 hours, p=0.58), or estimated blood loss (483±420 vs. 420±314 mL, p=0.65). There were no statistically significant differences between the two groups with respect to the rate of surgical (3 vs. 2, p=1.0), medical (4 vs. 3, p=1.0), neurological (3 vs. 4, p=0.7), or overall complications (10 vs. 9, p=1.0). In this study, moderate hypothermia via intravascular cooling catheters was successfully performed during 38 intradural spinal tumor surgeries. Compared to the historical control group, the hypothermia patients had longer hospital stays, but did not have higher complication rates. Intraoperative moderate hypothermia during spinal tumor resection is feasible and appeared safe in this limited cohort; however, further studies with larger cohorts will be needed to determine whether peri-operative hypothermia is an effective neuroprotectant strategy in spinal tumor surgery.
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Jeremiah N
authors.initials: JN
authors.lastname: Johnson
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Cummock
authors.forename: Allan D
authors.initials: AD
authors.lastname: Levi
authors.forename: Barth A
authors.initials: BA
authors.lastname: Green
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001833:Body Temperature Regulation; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult