Therapeutic hypothermia for severely head-injured patients with acute subdural haematoma.

The benefit of hypothermia therapy for severely head-injured patients has been a matter of controversy, and the appropriate indications have yet to be clarified. The authors have employed mild hypothermia to treat severe acute subdural haematoma (ASDH) patients postoperatively as a means of controlling intracranial pressure. The potential roles of hypothermia in the treatment of severe ASDH patients are discussed. Between 1997 and 2000, 18 ASDH patients with a GCS on admission of 6 or less were treated by haematoma evacuation with postoperative mild hypothermia. The efficacy of hypothermia was evaluated retrospectively by comparing the outcome of these 18 patients with that of 15 ASDH patients who underwent surgery without postoperative hypothermia between 1993 and 1996. Hypothermia significantly increased both the survival and favorable outcome rates of the 18 ASDH patients, compared with the historic controls. However, the benefit of hypothermia was seen only in ASDH patients without associated cerebral contusion, and no significant protective effect of hypothermia was seen in ASDH patients with contusion. Hypothermia may be a useful postoperative therapeutic modality for severe ASDH without concomitant cerebral contusion. A future prospective study is warranted to support the conclusions of this retrospective study.