Brain Protection

Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 21)


The concept of protection has a long history in medicine. The empirical use of cold for example, to attenuate the reactions to and consequences of injuries, particularly of brain injuries, has been acknowledged from the time of the Greeks (Frost 1981, Hoff 1986). The modern concept of brain protection however emerges in the fifties in the particular field of thoracic surgery. Resection of the aortic arch was attempted using temporary shunts and hypothermia (Cooley 1955) and later, circulatory arrest under extracorporeal circulation (De Bakey 1957) and deep hypothermia (Niazi and Lewis 1958). In these pioneering works as well as in subsequent developments in our own neurosurgical field (Rosomoff 1959, Drake 1964), protection means prevention and mitigation of a foreseeable ischemie insult (Fig. la) highly likely to occur in given circumstances. Brain protection associates on the one hand hemodynamic manipulations to avoid ischemia and, on the other hand, various pharmacological or physical methods aimed at reducing the metabolic demand to limit the consequences of ischemia if eventually it is in part unavoidable. In this first period of its development brain protection is based on hypometabolism, it is essentially an intraoperative procedure and it is inseparable from other anesthetic and resuscitation techniques. In fact it marks the beginning of modern neuroreanimation around hemodynamic and metabolic preoccupations (Campan 1981).


Cerebral Ischemia Middle Cerebral Artery Occlusion Focal Cerebral Ischemia Cerebral Vasospasm Circulatory Arrest 
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© Springer-Verlag/Wien 1994

Authors and Affiliations

  1. 1.Clinique Universitaire de Neurochirurgie Hôpital Pellegrin TripodeBordeauxFrance

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