World Neurosurg
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Neurosurgeons have been familiar with the idea that hypothermia is protective against various types of brain injuries, including traumatic brain injury (TBI). Recent randomized controlled trials, however, have failed to demonstrate the efficacy of therapeutic hypothermia (TH) in patients with TBI. On the other hand, TH becomes popular in the treatment of out-of-hospital cardiac arrest (OHCA) survivors, after randomized controlled trials have shown that survival rate and functional outcome is improved with the use of TH in selected patients. We believe that knowledge on the recent progress in TH for OHCA is useful for neurosurgeons, because feedback of information obtained in the treatment of OHCA may revitalize the interest in TH for neurosurgical disorders, particularly TBI. ⋯ Neurosurgeons and critical care medicine physicians pursue the same goal of rescuing the brain from the secondary injury despite the difference in etiology (focal trauma vs. global ischemia), with the presumption that earlier and faster implementation of TH will result in better outcome. Thoughtful application of knowledge and techniques obtained in OHCA to TBI under a rigorously controlled situation will make a small, but significant difference in the outcome of TBI victims.
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Comparative Study
Outcome following symptomatic cerebral vasospasm on presentation in aneurysmal subarachnoid hemorrhage: coiling vs. clipping.
Cerebral vasospasm complicates both surgical and endovascular treatment of ruptured aneurysms. The present study analyzes patients with presentation vasospasm (PVSP) treated in the acute setting and compares outcomes in those treated with surgical clipping versus endovascular coiling. ⋯ Outcome did not differ between aSAH patients treated in the presence of symptomatic vasospasm compared to those with subsequent vasospasm. The outcome of patients presenting with vasospasm was not influenced by the modality of aneurysm treatment. This suggests that both surgical and endovascular intervention for the treatment of ruptured aneurysms are equally valid options in the setting of existing symptomatic vasospasm.