-Objective:To evaluate the effectiveness of regional cooling for reducing brain temperature (BrTe) and intracranial pressure (ICP) in patients where conventional clinical treatment has failed. Method: Regional cooling was carried out using ice bags covering the area of the craniectomy (regional method) in 23 patients. The BrTe and ICP were determined using a fiber optic sensor. Thirteen patients (56.52%) were female. The ages ranged from 16 to 83 years (mean of 48.9). The mean APACHE II score was 25 points (11-35). The patients were submitted, on mean, to 61.7 hours (20-96) of regional cooling. Results: There was a significant reduction in mean BrTe (p<0.0001-from 37.1ºC to 35.2ºC) and mean ICP (p=0.0001-from 28 mmHg to 13 mmHg). Conclusion: Our results suggest that mild brain hypothermia induced by regional cooling was effective in the control of ICP in patients who had previously undergone decompressive craniectomy.KEy wORds: intracranial hypertension, intracranial pressure, cerebral hypothermia, brain edema, brain injuries. Resfriamento cerebral regional para redução da temperatura e pressão intracranianaResumo -Objetivo: Avaliar a eficácia do resfriamento regional na redução da temperatura cerebral (TeCe) e pressão intracraniana (PIC) após falha das medidas clínicas convencionais de tratamento. Método: O resfriamento cerebral foi realizado com bolsas com gelo, colocadas sobre a área de craniectomia (método regional) em 23 doentes. A TeCe e PIC foram verificadas com sensor de fibra óptica. Treze (56,52%) eram do sexo feminino. A idade variou de 16 a 83 anos (média 48,96). A pontuação média no índice APACHE II foi 25 pontos . Os doentes foram submetidos, em média, a 61,7 horas (20-96) de resfriamento regional. Resultados: Houve uma redução significativa da TeCe média (p<0,0001-de 37,1ºC para 35,2ºC) e da PIC média (p=0,0001-de 28 mmHg para 13 mmHg). Conclusão: Nossos resultados sugerem que o resfriamento regional foi eficaz no controle da PIC nos doentes submetidos, previamente, a craniectomia descompressiva.PAlAvRAs-CHAvE: hipertensão intracraniana, pressão intracraniana, hipotermia induzida, edema encefálico, traumatismos encefálicos.

RESUMO PALAVRAS-CHAVEInfarto da artéria cerebral média, cirurgia. Acidente cerebrovascular. Craniectomia descompressiva. ABSTRACT Massive cerebral infarction and decompressive craniectomy. Literature review KEY WORDSMiddle cerebral artery infarction, surgery. Cerebrovascular accident. Decompressive craniectomy.

Background:For neurosurgery, the last decades have been a time of incredible improvement in areas such as imaging, microscopy, endoscopy, stereotactic guidance, navigation, radiosurgery and endovascular techniques. However, the efficacy of topical antibiotic prophylaxis in neurological operations remains to be established by neurosurgeons.Methods:The authors did an historical review of the literature regarding the utilization of topical antibiotic prophylaxis in neurological operations. The Pub Med database of the U.S. National Library of Medicine / National Institutes of Health was utilized as the primary source of the literature. The authors performed the search by using the following Mesh terms: “neurosurgery” or “neurosurgical procedures” and “administration, topical” and “antibiotic prophylaxis”; “neurosurgery” or “neurosurgical procedures” and “administration, topical” and “antibacterial agents.”Results:In the last 70 years, we have poorly studied the use of topical antibiotics in neurosurgery. All the papers reported were Class III evidence.Conclusion:To the best of our knowledge, there is no publication that provided Class I or II evidence about topical antibiotic prophylaxis in neurosurgery.

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These results suggest that inlet radiographs may be a reliable method of assessing the reduction of the hip after the surgical treatment of DDH. Cite this article: 2017;99-B:697-701.