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Neurosurgical Forum: Letters to the Editor To The Editor Juan Sahuquillo , M.D., Ph.D. Vall d'Hebron University Hospital Barcelona, Spain Alberto Biestro , M.D. Corina Puppo , M.D. Hospital de Clìnicas Montevideo, Uruguay 735 739 Abstract Object. This study was performed to determine whether moderate hypothermia (31°C) improves clinical outcome in severely head injured patients whose intracranial hypertension cannot be controlled using mild hypothermia (34°C). Methods

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Carrie G. Markgraf, Guy L. Clifton and Melanie R. Moody

M oderate hypothermia (30–32°C) therapy has been shown to reduce behavioral deficits in animal models of stroke 11 and TBI. 3, 5, 8 The mechanism of this protective effect is still a matter of debate. There are conflicting reports of hypothermia's effect on glutamate release following TBI, 9, 18 and hypothermia has been shown to affect a variety of biochemical markers of brain injury. 10, 13, 21, 23, 24 It is difficult to link these cellular changes in the brain with improved behavioral outcome, however, and thus there is continued speculation concerning

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Leonid I. Groysman, Benjamin A. Emanuel, May A. Kim-Tenser, Gene Y. Sung and William J. Mack

T herapeutic hypothermia was first described in the Edwin Smith Papyrus, the oldest medical text known to man. History books have since repeatedly documented efficacy in the resuscitation of coldwater drowning victims. In the 1930s, Dr. Temple Fay, an American neurosurgeon, pioneered the use of hypothermia in the treatment of neurological disease. 8 The concept was first applied to patients with intractable pain, and later to intracranial processes such as traumatic brain injury, abscesses, and cerebritis. In the 1950s, hypothermia was effectively used in

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Tadahiko Shiozaki, Yoshikazu Nakajima, Mamoru Taneda, Osamu Tasaki, Yoshiaki Inoue, Hitoshi Ikegawa, Asako Matsushima, Hiroshi Tanaka, Takeshi Shimazu and Hisashi Sugimoto

W e have reported that mild hypothermia (34°C) is effective in preventing the elevation of ICP in severely head injured patients whose ICP remains higher than 20 mm Hg but lower than 40 mm Hg after undergoing conventional therapies. 14, 15 Our findings are consistent with those of other investigators: mild hypothermia significantly reduces high ICP in patients with severe head injury. 7, 11 Even in the National Acute Brain Injury Study, Clifton, et al., 3 mentioned that mild hypothermia reduced elevated ICP. Nevertheless, they concluded that mild

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Huan Wang, William Olivero, Giuseppe Lanzino, William Elkins, Jean Rose, Debra Honings, Mary Rodde, Jan Burnham and David Wang

T o date, hypothermia is by far the most potent method of neuroprotection in animal studies and has the greatest therapeutic potential. 2, 5, 17, 24, 25, 42, 43, 46 Nevertheless, problems remain with timely and safe delivery of this type of therapy. 9 Although the results of clinical trials have been mixed, 3, 9, 31, 45 two large prospective randomized clinical trials of resuscitative hypothermia for cardiac arrest have recently shown significant benefit. 3, 31 Preclinical and clinical investigation of hypothermia continues to receive intense attention

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Michael A. Bohl, Nikolay L. Martirosyan, Zachary W. Killeen, Evgenii Belykh, Joseph M. Zabramski, Robert F. Spetzler and Mark C. Preul

F or millennia, physicians have recognized the therapeutic effect of hypothermia on patients suffering neurological illness or trauma. Indeed, these attempts to preserve or rescue neural tissue are ultimately designed to preserve function. In more modern times, neurosurgeons have attempted to use surgery or specialized treatments to influence complex brain or spinal cord functions. History has shown this journey to be filled with tremendous promise and enormous pain. Accounts of hypothermic patients seemingly miraculously recovering from typically fatal

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Guy L. Clifton, Christopher S. Coffey, Sierra Fourwinds, David Zygun, Alex Valadka, Kenneth R. Smith Jr., Melisa L. Frisby, Richard D. Bucholz, Elisabeth A. Wilde, Harvey S. Levin and David O. Okonkwo

W e performed 2 randomized, multicenter trials of hypothermia induction in patients with severe TBI (NABIS:H I and NABIS:H II; clinical trial registration no.: NCT00178711). The second trial differed from the first primarily in that hypothermia was induced much earlier after injury and a unified protocol led to a reduced rate of hypothermia-induced hypotension. In both trials, we performed a set of subgroup analyses that were specified before unblinded data were examined. In these subgroup analyses, we analyzed the differences between treatment effect in

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Eisha Christian, Gabriel Zada, Gene Sung and Steven L. Giannotta

T raumatic brain injury remains a significant cause of morbidity and death in the US and worldwide. The Centers for Disease Control and Prevention estimates that at least 5.3 million Americans, or ~ 2% of the US population, currently have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI. 38 Current nonsurgical treatment strategies following TBI consist primarily of ICP management and cardiopulmonary support measures. Although resuscitative hypothermia was initially described as early as 1897 32 and has been

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Hiroshi Karibe, Gregory J. Zarow and Philip R. Weinstein

B rief temporary cerebral arterial occlusion for less than 1 hour has been used to prevent intraoperative bleeding and to facilitate dissection during surgery for intracranial aneurysms 2, 22, 43, 44 and removal of arteriovenous malformations. 24 Deep-to-moderate (30°C) hypothermia has been used to minimize ischemic injury induced by temporary vessel occlusion; 2, 22, 34, 42 however, deep hypothermia for purposes other than cardiopulmonary bypass was abandoned because it was complicated by ventricular fibrillation, acidosis, shivering, bleeding dyscrasias

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Harvey M. Shapiro, Stephen R. Wyte and John Loeser

of these observations suggest that barbiturates, especially those with a prolonged effect, might be useful in the management of unyielding intracranial hypertension in comatose patients. Hypothermia can also reduce intracranial tension. To obtain the maximum effect patients should be cooled below 27°C. 16 Temperatures in this range are associated with cardiovascular instability and an increased incidence of ventricular fibrillation. 12 Because of the similar effect of barbiturates 14 and hypothermia 17 on cerebral metabolism and ICP, we hypothesized that ICP