Decompressive Craniectomy in a Patient with Severe Traumatic Brain Injury during Mild Therapeutic Hypothermia
Mild Therapeutic Hypothermia (MTH) and decompressive craniectomy are therapeutic measures used for the treatment of intracranial hypertension (ICHT) refractory to medical treatment and cerebrospinal fluid drainage. One of the side effects of MTH is the increased risk of coagulopathy, thus the performance of neurosurgical procedures in these cases is very controversial.We present the case of a patient with traumatic brain injury and ICHT refractory to medical treatment, in which moderate therapeutic hypothermia was initiated. After a transient improvement, the patient presented ICHT again, requiring a decompressive craniotomy while keeping the patient in moderate hypothermia. Due to the history of traumatic brain injury and the use of MTH, we decided on the use of viscoelastic tests as goal-directed therapy to assess haemostasis prior to surgery.