{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T11:48:28Z","timestamp":1782388108558,"version":"3.54.5"},"reference-count":17,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Finnish government"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Cereb Blood Flow Metab"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Therapeutic hypothermia is neuroprotective after brain injury, reducing metabolic demand, inflammation, and secondary injury cascades. However, clinical application is limited by systemic side effects, and selective brain cooling without systemic hypothermia has not been demonstrated in large mammals. We aimed to demonstrate the feasibility of selective brain cooling using cerebrospinal fluid (CSF) exchange with cooled saline via a double-lumen external ventricular drain (EVD) system in a porcine model. Using 12 pigs under general anesthesia, we placed a double-lumen EVD in the lateral ventricle and a lumbar spinal drain to enhance CSF outflow. Cooled NaCl (13\u2009\u00b0C) was infused at 120, 360, or 720\u2009mL\/h while maintaining intracranial pressure. After reperfusion, mean arterial pressure was increased to 140\u2009mmHg. Brain temperatures were recorded bilaterally; core temperature was monitored. Ipsilateral brain temperature decreased by 7.5\u2009\u00b0C, contralateral cooled by 3.1\u2009\u00b0C. Core temperature remained stable. Target temperature was reached in 1.5\u2009h at 120\u2009mL\/h, and within 10\u201315\u2009min at 360\u2013720\u2009mL\/h. Arrhythmias occurred with NaCl but not with Ringer\u2019s acetate. We demonstrate that selective brain cooling is feasible in a large mammal model via CSF exchange without systemic hypothermia. This method may offer a safe, controllable approach for neuroprotection.<\/jats:p>","DOI":"10.1177\/0271678x251405652","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T09:01:10Z","timestamp":1768554070000},"page":"838-842","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Selective brain cooling via cerebrospinal fluid exchange: Proof of concept in a porcine model"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3937-2816","authenticated-orcid":false,"given":"Behnam","family":"Rezai Jahromi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland"},{"name":"Neurosurgery Research Group, Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaakko","family":"Kauhanen","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, A.I. 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