[Intravascular hypothermia for cerebral ischemia after microsurgical clipping of complex MCA aneurysms].

Autor:	Konovalov AN; Burdenko Neurosurgical Center, Moscow, Russia., Pilipenko YV; Burdenko Neurosurgical Center, Moscow, Russia., Tsarukaev BA; Burdenko Neurosurgical Center, Moscow, Russia., Baranich AI; Burdenko Neurosurgical Center, Moscow, Russia., Oshorov AV; Burdenko Neurosurgical Center, Moscow, Russia., Eliava SS; Burdenko Neurosurgical Center, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko [Zh Vopr Neirokhir Im N N Burdenko] 2022; Vol. 86 (2), pp. 36-44.
DOI:	10.17116/neiro20228602136
Abstrakt:	Hypothermia for neuroprotection and correction of intracranial hypertension was described in both experimental and clinical studies. Effectiveness of hypothermia for improvement of functional outcomes in neurosurgical patients is still unclear despite the previous randomized trials. In available national and foreign literature, we found no trials devoted to hypothermia in patients with ischemia after surgical treatment of complex aneurysms of the middle cerebral artery (MCA). Objective: To analyze the effectiveness of intravascular hypothermia in patients with ischemic cerebrovascular accidents in early postoperative period after microsurgical clipping of complex MCA aneurysms. Material and Methods: We present four patients with cerebral ischemia after microsurgical treatment of complex MCA aneurysms. In all cases, ischemic disorders developed immediately after surgery. We induced intravascular hypothermia 32-34 °C in all patients. CT-based volumetry of ischemia and edema foci was performed to objectively assess the dynamics of ischemic disorders. We carried out volumetry using segmentation of edema and ischemia foci (range 5-33 Hounsfield units). Results: According to brain CT data, all four patients had enlargement of postoperative ischemic brain damage. Nevertheless, ICP was stable that made it possible to avoid decompressive craniotomy. Conclusion: Early hypothermia for acute ischemic injury after surgery for complex MCA aneurysms can reduce ischemic perifocal edema. This approach effectively reduces ICP and can exclude the need for decompressive craniotomy in some cases. No side effects of hypothermia justifies further research in this field.
Databáze:	MEDLINE
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