Hyperbaric oxygen as an adjunct to acute revascularization of the brain

Two recent cases suggest that hyperbaric oxygen may be an important adjunct to the surgical treatment of occlusion of major cerebral arteries within the first few hours after onset of neurological deficit. In both patients, one with an embolus to the right middle cerebral artery and one with a surgical occlusion of the left internal carotid artery, circulation to the ischemic area was restored more than eight hours after occlusion. In the patient with the middle cerebral artery embolus, hemiplegia cleared after a six-minute exposure to hyperbaric oxygen. The patient with occlusion of the internal carotid artery was revascularized by anastomosis of a superficial temporal artery less than 1 mm in diameter to a branch of the middle cerebral artery. Her hemiplegia and aphasia cleared rapidly and concomitantly with intermittent exposure to hyperbaric oxygen during the first nine postoperative days. Postoperative angiograms demonstrated patency in both cases. The implications of these observations are discussed.