Neurocritical Care

, Volume 15, Issue 1, pp 101–106

The Effect of Decompressive Hemicraniectomy on Brain Temperature After Severe Brain Injury

  • Kazuma Nakagawa
  • Nancy K. Hills
  • Hooman Kamel
  • Diane Morabito
  • Pratik V. Patel
  • Geoffrey T. Manley
  • J. Claude HemphillIII
Original Article

Abstract

Background

Animal studies have shown that even a small temperature elevation of 1°C can cause detrimental effects after brain injury. Since the skull acts as a potential thermal insulator, we hypothesized that decompressive hemicraniectomy facilitates surface cooling and lowers brain temperature.

Methods

Forty-eight patients with severe brain injury (TBI = 38, ICH = 10) with continuous brain temperature monitoring were retrospectively studied and grouped into “hemicraniectomy” (n = 20) or “no hemicraniectomy” (n = 28) group. The paired measurements of core body (TCore) and brain (TBr) temperature were recorded at 1-min intervals over 12 ± 7 days. As a surrogate measure for the extent of surface heat loss from the brain, ∆TCore−Br was calculated as the difference between TCore and TBr with each recording. In order to accommodate within-patient temperature correlations, mixed-model regression was used to assess the differences in ∆TCore−Br between those with and without hemicraniectomy, adjusted for core body temperature and diagnosis.

Results

A total of 295,883 temperature data pairs were collected (median [IQR] per patient: 5047 [3125–8457]). Baseline characteristics were similar for age, sex, diagnosis, incidence of sepsis, Glasgow Coma Scale score, ICU mortality, and ICU length of stay between the two groups. The mean difference in ∆TCore−Br was 1.29 ± 0.87°C for patients with and 0.80 ± 0.86°C for patients without hemicraniectomy (P < 0.0001). In mixed-model regression, accounting for temperature correlations within patients, hemicraniectomy and higher TCore were associated with greater ∆TCore−Br (hemicraniectomy: estimated effect = 0.60, P = 0.003; TCore: estimated effect = 0.21, P < 0.0001).

Conclusions

Hemicraniectomy is associated with modestly but significantly lower brain temperature relative to core body temperature.

Keywords

Decompressive hemicraniectomy Brain temperature Brain tissue oxygen monitor 

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Kazuma Nakagawa
    • 1
    • 2
  • Nancy K. Hills
    • 2
  • Hooman Kamel
    • 2
  • Diane Morabito
    • 3
    • 4
  • Pratik V. Patel
    • 5
  • Geoffrey T. Manley
    • 3
    • 4
  • J. Claude HemphillIII
    • 2
    • 4
  1. 1.Department of Neurovascular ServiceUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of NeurologyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Department of NeurosurgeryUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoUSA
  5. 5.Department of Neurological SciencesRush University Medical CenterChicagoUSA

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