Stress
Hypothermia is a new aid to surgery and carefully used may prove of great benefit, but it carries risks, and therefore much more must be learned about its effect upon body metabolism and upon cell life.
Abstract
tive paper on the surgical management of aneurysms. With one exception their series include every case of subarachnoid haemorrhage admitted during a period of twelve months in which angiography demonstrated an aneurysm-a total of 22 patients, of whom 3 died. In 10 cases the aneurysm arose from either the anterior cerebral or the anterior communicating artery, and in this group there was one death. The operations took place at intervals after the rupture of from 4 hours to 44 days. In every case the aneurysm was exposed by a craniotomy and dealt with by the application of clips or by some similar measure. Hypothermia was used, and reduction of the cerebral circulation by temporary occlusion of the great vessels in the neck during the period of manipulating the aneurysm was carried out in 14 cases. Four patients who had their common carotid and vertebral arteries on both sides compressed for from 2 to 11 minutes made an excellent recovery, except one who was left with a severe neurological defect. It remains to be seen whether results as good as these will be obtained in a larger series, with a greater proportion of patients with more serious initial brain damage. But this report certainly encourages optimism in a field of emergency neurosurgery which has been full of disappointments, and it shows the value of combining hypothermia with methods of reducing the cerebral circulation. Hypothermia is a new aid to surgery and carefully used may prove of great benefit, but it carries risks, and therefore much more must be learned about its effect upon body metabolism and upon cell life.