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J Neurol Surg A Cent Eur Neurosurg 2017; 78(04): 397-402
DOI: 10.1055/s-0036-1596057
Technical Note
Georg Thieme Verlag KG Stuttgart · New York

Selective Brain Cooling after Traumatic Brain Injury: Effects of Three Different Cooling Methods—Case Report

Thomas Westermaier
1   Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany
,
Robert Nickl
1   Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany
,
Stefan Koehler
1   Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany
,
Patrick Fricke
1   Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany
,
Christian Stetter
1   Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany
,
Stefan Mark Rueckriegel
1   Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany
,
Ralf-Ingo Ernestus
1   Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany
› Author Affiliations
Further Information

Publication History

03 April 2015

26 August 2016

Publication Date:
30 December 2016 (online)

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Abstract

Background In 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.

Methods Three 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.

Results External 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.

Conclusion Previous 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.

Keywords

selective brain cooling - hypothermia - traumatic brain injury - TBI - intracranial pressure
 

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