Report of 10 operations under local cerebral hypothermia.

A method of local cerebral hypothermia with circulatory arrest of one or more of the major vessels of the neck is described. Ten clinical cases have been operated upon, and much has been learned of the operative difficulties including an increased operating time and a high complication rate. There were four post-operative deaths, in one (case 1) there was some evidence that the technique protected the perfused part of the brain from anoxic damage. In case 9 the method itself caused particularly bad operating conditions and eventually the patient died. Case 2 and case 4, like case 1, were patients who were severely ill and who might well have died whatever technique had been used in operating upon them. Of the survivors, one patient (case 3) had a post-operative intracerebral clot which developed during closure and another (case 6) had an intracerebral clot which required removal after 24 hours. Another patient (case 8) had some delay in return to full mental function. In the light of this experience we cannot regard the method in its present form as satisfactory for general use. In our view, its further development requires the discovery of a more effective means of neutralizing the anticoagulants, or doing without anticoagulants altogether. It is also necessary to develop a method of monitoring parts of the brain distant from those directly perfused to give warning of threatened anoxia. Until such time as these problems can be solved we have returned to other procedures but are publishing our results in the hope that other workers will be able to improve upon them.