Abstract
In the past, massive intraoperative brain swelling has usually been associated with a fatal outcome. This report describes the use of large doses of thiobarbiturate as a means of treating massive intraoperative brain swelling. The results of the initial eleven cases, (five arteriovenous malformations, four hematomas, and two penetrating injuries), are as follows: six patients made a good recovery, one is moderately disabled, one is severely disabled, and two are dead. These data suggest that this condition, which once was considered unmanageable, can indeed be managed and that treatment often results in an acceptable outcome. Furthermore, more recent experience suggests that the use of planned, deep thiobarbiturate anesthesia, with induced electrocerebral silence during intracranial operations, may even prevent the occurrence of this phenomenon.
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