gms | German Medical Science

Objective: Hyperbaric oxygen (HBO) treatment seems to improve the result and outcome of patients in some experimental and clinical studies of neurological and neurosurgical diseases such as brain trauma and spinal cord injury, decompression illness of the central nervous system, intracranial and spinal infections, recurrent malignant brain tumors and ischemic brain tissue damage. We sought to investigate the clinical usefulness and effect of hyperbaric oxygen (HBO) therapy on six patients with complex ischemic cerebrovascular diseases.

Method: Medical records of patients in the period from January 2012 to November 2014 admitted to our neurosurgical institution with diagnosis and symptoms of complex ischemic cerebrovascular diseases treated with HBO therapy were in a retrospective review analyzed. Exposure to HBO was administered in a hyperbaric chamber with 3x30 min of 100% oxygen inhalation using an oxygen mask at 2.4 atmospheres absolute. Number of HBO therapy sessions and physiological parameters of the patients during HBO therapy were as much evaluated as the imaging vascular diagnostics (carotid ultrasound, SPECT-CT ± Diamox, MR-angio), the neurological status before and after HBO treatment.

Results: Six patients (3 men, 3 women) received HBO treatment in cases where operative therapy was not indicated as first choice option or by absence of pathological diagnostic findings. The maximum number of HBO sessions per patient was 17, the minimum 1 (median value 3.5). In one case HBO therapy failed because of oxygen mask discomfort for the patient. Main diagnoses of patients were cerebral artery stenosis (ACA, ACI), cerebral microangiopathy and ischemia of the cervical myelon, CADASIL and dizziness of unclear origin. The clinical symptoms of patients were dizziness (5x), TIA complaints (2x), gait disturbances (2x), headaches (1x) and tetraparesis (1x). 3 of 6 patients (50%) reported after HBO therapy about improvement of their clinical neurological symptoms. No major side effects of HBO treatment could be observed.

Conclusions: Hyperbaric oxygen therapy in neurosurgery is an alternative and additional option in the treatment of patients suffering from complex ischemic cerebrovascular diseases where operative therapy is not indicated. However the optimal levels of oxygen pressure as well as duration and numbers of HBO sessions need to be specified in larger studies before HBO therapy can be routinely recommended in clinical practice.