Therapeutic Hypothermia after Decompressive Craniectomy in Malignant Cerebral Infarction

• Published in: Acute and critical care Vol. 29; no. 2; pp. 93 - 98
• Main Authors: Jun Young Chang, Jeong Ho Hong, Jin Heon Jeong, Sung Jin Nam, Ji Hwan Jang, Jae Seung Bang, Moon Ku Han
• Format: Journal Article
• Language: English
• Published: Korean Society of Critical Care Medicine 01-05-2014; 대한중환자의학회
• Subjects: brain edema; cerebral infarction; decompressive craniectomy; hypothermia; 마취과학
• ISSN: 2383-4870; 2586-6052; 2586-6060
• DOI: 10.4266/kjccm.2014.29.2.93

Decompressive hemicraniectomy followed by subsequent therapeutic hypothermia can reduce mortality in patients with malignant cerebral infarction without significantly increasing risk. We report three cases of malignant cerebral infarction treated with hemicraniectomy followed by hypothermia. Case 1 received elective decompressive surgery and hypothermia. Case 2 developed subsequent cerebral infarction with uncal herniation. Therefore, emergent decompressive surgery and hypothermia was performed in this case. Despite surgery and hyperosmolar therapy, case 3 received hypothermia treatment for refractory increased intracranial pressure. All patients survived with a score of 4 or 5 on the modified Rankin scale. Therefore, we suggest that application of hypothermia after hemicraniectomy is safe and feasible. Several possible modifications can be made to improve the management strategy in order to increase the benefits of hypothermia treatment.