Cooling for cerebral protection during brain surgery

Milani WRO, Antibas PL, Prado GF

Published Online:

October 5, 2011

The brain is at risk of low blood flow during a variety of neurosurgical procedures and this can lead to devastating results. Induced hypothermia is the controlled lowering of the core body temperature in order to avoid the problems associated with low blood flow. Brain surgery may lead to severe complications due to factors such as trauma from retracting the brain, vessel occlusion, and intraoperative haemorrhage. Many anaesthetists believe that induced hypothermia is indicated to protect the central nervous system during surgery. We found four studies that enrolled 1219 participants for this review.There was no evidence of any important differences in outcome for hypothermia for cerebral protection and normothermia during brain surgery.

Abstract (click to read)

Background:

The brain is at risk of ischaemia during a variety of neurosurgical procedures, and this can lead to devastating results. Induced hypothermia is the controlled lowering of core body temperature for therapeutic purposes. This remains the current practice during neurosurgery for the prevention or minimization of ischaemic brain injury. Brain surgery may lead to severe complications due to factors such as requirement for brain retraction, vessel occlusion, and intraoperative haemorrhage. Many anaesthesiologists believe that induced hypothermia is indicated to protect the central nervous system during surgery. Although hypothermia is often used during brain surgery, clinical efficacy has not yet been established.

Objectives:

To evaluate the effectiveness and safety of induced hypothermia versus normothermia for neuroprotection in patients undergoing brain surgery.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 10), MEDLINE, LILACS, EMBASE and Current Controlled Trials (from inception to November 2010), reference lists of identified trials, and bibliographies of published reviews. We also contacted researchers in the field. There were no language restrictions.

Selection criteria:

We included randomized controlled trials and quasi-randomized controlled trials of induced hypothermia versus normothermia for neuroprotection in patients undergoing brain surgery.

Data collection and analysis:

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information.

Main results:

We included four trials of cooling for cerebral protection during brain surgery, involving a total of 1219 patients. We did not find any evidence that hypothermia for neuroprotection in patients undergoing brain surgery is either effective or unsafe when compared to normothermia.

Authors' conclusions:

Although there is some evidence that mild hypothermia is safe, its effectiveness is not clear when compared with normothermia. We need to perform more clinical trials in order to establish the benefit, if any, of hypothermia for cerebral protection during brain surgery before making firm recommendations for the routine use of this intervention.

This record should be cited as:

Milani WRO, Antibas PL, Prado GF. Cooling for cerebral protection during brain surgery. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD006638. DOI: 10.1002/14651858.CD006638.pub2

Assessed as up to date:

November 6, 2010

Find the research

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Primary Review Group:

Anaesthesia Group

Health topics:

Anaesthesia & pain control > Peri-anaesthetic/peri-operative care > Peri-operative management of the anaesthetic patient

Neurology > Neurosurgery

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Cooling for cerebral protection during brain surgery

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