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Fever is a proven factor in secondary brain damage and worsens outcome in neuro intensive care patients. However, large randomized studies have shown neuroprotective effects of induced hypothermia only in patients with cardiac arrest and in neonates with perinatal hypoxic-ischemic brain damage. Nevertheless, now there is an active search for alternative modes of temperature correction, which would have been effective in other groups of patients with brain damage. Moreover, new management techniques of body temperature are being created. In this paper we presented a series of 10 observations when the used cooling system was CoolGard/CoolLine. 5 patients underwent hypothermia, 5 patients normothermia . Hypothermia was used for cerebroprotection in 1 case and for the correction of resistance to the therapy of intracranial hypertension in 4 cases. Normothermia was used for correction of resistance to pharmacological treatment of fever. In all cases the target temperature was achieved, and only for 1 patient to achieve hypothermia additional external cooling was used. Patients with normothermia did not need sedation, because they have not developed discomfort and muscle tremor. 2 patients died, in one case was due to intracranial hypertension and hemotamponade of brain ventricular system. Cause of second death was pulmonary embolism. Thus, the CoolGard system effectively lowers the body temperature to the target values for neuro intensive care patients. Application of this system is relatively safe. However, the most dangerous are the thromboembolic complications, thus the daily ultrasound scanning of lower limb veins and the possible early use of low molecular weight heparins is crucial.

This was a retrospective study. Its inclusion criterion was mechanical ventilation (MV) for more than 48 hours. One hundred and eighty-four case records of 184 neurosurgical intensive care unit patients were analyzed. Ventilation modes, upper airway cares and prosthetic replacement were chosen by the protocol accepted at the Institute. Great differences were found in the structure of indications for MV and in the duration of respiratory support in relation to the neurosurgical nosological entity and the site of a major process. The upper airway care protocols accepted at the Institute were shown to reduce the incidence of ventilator-associated pneumonia. Some risk factors for ventilator-associated pneumonia were identified.

We present a rare clinical observation of progressive development of neurological symptoms up to comatose state in a child with extra-intraventricular craniopharyngioma in delayed postoperative period due to seizure-free status epilepticus which was diagnosed only by EEG-monitoring. Concerning this case report, we discuss genesis of seizure-free status epilepticus and its possible role in development of severe condition in patients with different kinds of neurosurgical pathology in postoperative period.

The efficacy of Sterofundin, Normofundin, and physiological solutions in correcting hypernatremia and impaired acid-base balance was analyzed in patients with sellar region tumors. Twenty-one patients were enrolled in the study; three groups were formed. Physiological solution added by 4% of potassium chloride and 25% magnesium sulfate solution was used in Group 1 (n = 7). Normofundin was employed in Group 2 (n = 7). Sterofundin was applied to Group 3 (n = 7). The volume of administered fluid corresponded to the sum of volumes of basic needs and those of fluid losses. The study revealed that the most adequate correction of hypernatremia was seen with the use of Sterofundin. The use of Normofundin is associated with a risk of a rapid and significant reduction in the level of sodium and that of physiological solution fails to correct hypernatremia. Metabolic alkalosis was typical for all the patients included into the study. Its effective correction was noted only when Sterofundin was used.

The article discusses results of surgical treatment of 82 patients with large and giant cerebral aneurysms operated in Burdenko Neurosurgical Institute (Moscow, Russia) during the recent 14 years. Special attention was given to benefits of intravascular blood aspiration (IBA) technique. This technique was proven to be very effective, allowing to clip the aneurysm in 87.8% of cases with good recovery in 41.5% and with moderate disability in 39%. Postoperative mortality was 4.9% (4 patients). The authors suggested original surgical classification of large and giant aneurysms. IBA was ineffective in cases of giant partially thrombosed aneurysms with sclerotic walls and giant aneurysms with very wide neck. These aneurysms require other surgical procedures such as embolization of ICA followed by extraintracranial bypass or high-flow bypass.

In the presented case, clipping of aneurysm of the anterior cerebral artery (A CeA) and the anterior communicating artery (ACoA) in acute subarachnoidal hemorrhage (SAH) was complicated by the development of vasospasm and transient diabetes insipidus (DI). The cause of DI was ischemia of the anterior portions of the hypothalamus due to ACeA and ACoA spasm. The use of the standard triple H-therapy protocol in the presence of DI failed to achieve the optimal parameters of hemodynamics and cerebral perfusion pressure due to the development of severe polyuria. Addition of the standard triple H-therapy protocol by hormonal replacement therapy with desmopressin could yield adequate systemic hemodynamic parameters. During this treatment, the state became stable and vasospasm regressed. The manifestations of DI ceased with the values of cerebral circulation being normal.

Cerebral vasospasm and its associated ischemia are one of the main causes of death in 23% of patients with prior aneurysmal subarachnoidal hemorrhage (SAH). At present, a diversity of approaches to treating vasospasm has been developed, among them hypertensive hypervolemic hemodilution (deriving its abbreviated name 3H-therapy) offers certain advantages. At the same time a number of aspects of application of this approach remain unclear. Fifty-four patients with significant cerebral arterial spasm (elevated linear systolic blood flow velocity > or = 200 cm/s) who had been operated on in the acute period of aneurysmal SAH were selected. Of them, 18 patients had undergone hypervolemic hypertensive hemodilution (3H-therapy) under guidance of systemic hemodynamics, by using a Swan-Ganz catheter (these patients formed a study group). Thirty-six patients who had not undergone 3H-therapy under invasive monitoring of systemic hemodynamics constituted a control group. Hypervolemic hypertensive hemodilution was performed by means of continuous intravenous infusion of a combination of colloid-crystalloid solutions. The therapy was considered to be adequate by meeting the following requirements: maintenance of cardiac index not less 3.5 l/min/m2, pulmonary capillary wedge pressure below 14-16 mm Hg or central venous pressure under to 8-10 mm Hg, packed cell volume below 28-32%, and systolic blood pressure under 200 mm Hg. Hypervolemic hypertensive hemodilution (3H-therapy) applied to patients operated on in the acute period of aneurysmal SAH was effective in increasing cardiac output, central venous pressure, systemic arterial pressure and hence cerebral perfusion with the minimum number of complications unassociated with the use of this technique. This permitted a reduction in mortality rates in patients with baseline Hunt-Hess grade I-III SAH. At the same time, it should be emphasized that 3H-therapy may be used in neurosurgical patients, by thoroughly monitoring the parameters of central hemodynamics, blood coagulation system, cerebral circulation and, desirably, intracranial pressure.