title: Selective Brain Cooling after Traumatic Brain Injury: Effects of Three Different Cooling Methods-Case Report.
abstract: BackgroundIn experimental models of neuronal damage, therapeutic hypothermia proved to be a powerful neuroprotective method. In clinical studies of traumatic brain injury (TBI), this very distinct effect was not reproducible. Several meta-analyses draw different conclusions about whether therapeutic hypothermia can improve outcome after TBI. Adverse side effects of systemic hypothermia, such as severe pneumonia, have been held responsible by some authors to counteract the neuroprotective effect. Selective brain cooling (SBC) attempts to take advantage of the protective effects of therapeutic hypothermia without the adverse side effects of systemic hypothermia.MethodsThree different methods of SBC were applied in a patient who had severe TBI with recurrent increases of intracranial pressure (ICP) refractory to conventional forms of treatment: (1) external cooling of the scalp and neck using ice packs prior to hemicraniectomy, (2) external cooling of the craniectomy defect using ice packs after hemicraniectomy, and (3) cooling by epidural irrigation with cold Ringer solution after hemicraniectomy.ResultsExternal scalp cooling before hemicraniectomy, external cooling of the craniectomy defect, and epidural irrigation with cold fluid resulted in temperature differences (brain temperature to body temperature) of - 0.2°, - 0.7°, and - 3.6°C, respectively. ICP declined with decreasing brain temperature.ConclusionPrevious external cooling attempts for SBC faced the problem that brain temperature could not be lowered without a simultaneous decrease of systemic temperature. After hemicraniectomy, epidural irrigation with cold fluid may be a simple and effective way to lower ICP and apply one of the most powerful methods of cerebroprotection after severe TBI.
authors.affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Westermaier
authors.affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Nickl
authors.affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Koehler
authors.affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Fricke
authors.affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stetter
authors.affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: Stefan Mark
authors.initials: SM
authors.lastname: Rueckriegel
authors.affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: Ralf-Ingo
authors.initials: RI
authors.lastname: Ernestus
mesh_terms: D001921:Brain / Q000503:physiopathology / Q000601:surgery; D000070642:Brain Injuries, Traumatic / Q000503:physiopathology / Q000601:surgery*; D056424:Decompressive Craniectomy; D004824:Epidural Space; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D012535:Scalp; D012886:Skull; D007507:Therapeutic Irrigation