The Brain Research Laboratory at the Cleveland Metropolitan General Hospital and case Western Reserve University

The history of therapeutic hypothermia and its use in neurosurgery

Despite an overwhelming history demonstrating the potential of hypothermia to rescue and preserve the brain and spinal cord after injury or disease, clinical trials from the last 50 years have failed to show a convincing benefit. This comprehensive review provides the historical context needed to consider the current status of clinical hypothermia research and a view toward the future direction for this field. For millennia, accounts of hypothermic patients surviving typically fatal circumstances have piqued the interest of physicians and prompted many of the early investigations into hypothermic physiology. In 1650, for example, a 22-year-old woman in Oxford suffered a 30-minute execution by hanging on a notably cold and wet day but was found breathing hours later when her casket was opened in a medical school dissection laboratory. News of her complete recovery inspired pioneers such as John Hunter to perform the first complete and methodical experiments on life in a hypothermic state. Hunter's work helped spark a scientific revolution in Europe that saw the overthrow of the centuries-old dogma that volitional movement was created by hydraulic nerves filling muscle bladders with cerebrospinal fluid and replaced this theory with animal electricity. Central to this paradigm shift was Giovanni Aldini, whose public attempts to reanimate the hypothermic bodies of executed criminals not only inspired tremendous scientific debate but also inspired a young Mary Shelley to write her novel Frankenstein. Dr. Temple Fay introduced hypothermia to modern medicine with his human trials on systemic and focal cooling. His work was derailed after Nazi physicians in Dachau used his results to justify their infamous experiments on prisoners of war. The latter half of the 20th century saw the introduction of hypothermic cerebrovascular arrest in neurosurgical operating rooms. The ebb and flow of neurosurgical interest in hypothermia that has since persisted reflect our continuing struggle to achieve the neuroprotective benefits of cooling while minimizing the systemic side effects.

From Hypothermia to Cephalosomatic Anastomoses: The Legacy of Robert White (1926-2010) at Case Western Reserve University of Cleveland

Dr. Robert J. White (1926-2010) was an eminent neurosurgeon and bioethicist, renowned for his classic work in hypothermia and pioneering mammalian head transplant experiments. He founded the Division of Neurosurgery at the Cleveland Metropolitan General Hospital (currently MetroHealth Medical Center, a level 1 trauma county hospital) and became the youngest full professor at the Case Western Reserve University in Cleveland, Ohio. With over 500 research articles to his credit, he founded the Brain Research Laboratory at what was then the Cleveland Metropolitan General Hospital, which was also home to future leaders in neurosurgery, neurosciences, and allied specialties. He transferred a healthy monkey head onto a surgically beheaded monkey body under deep hypothermic conditions drawing both laurels and criticisms alike. Despite a largely controversial neurosurgical research career, his original contributions to deep hypothermia have found profound clinical applications in modern trauma and vascular neurosurgery. The new fusogens and myelorrhaphy methods being tried in Europe hold promise for a future of reanastomosing 2 homologous or heterologous tracts in the neuraxis.