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

Abstract

To analyze the effectiveness of intravascular hypothermia in patients with ischemic cerebrovascular accidents in early postoperative period after microsurgical clipping of complex MCA aneurysms. 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). 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. 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.