1. DECOMPRESSIVE CRANIECTOMY FOR INTRACEREBRAL HEMORRHAGE
- Author
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Aysan Durukan, Shashank Shekhar, Olga Vekovischeva, Eric Pedrono, Turgut Tatlisumak, Ivan Marinkovic, Usama Abo-Ramadan, Esa R. Korpi, and Daniel Strbian
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Blood transfusion ,medicine.medical_treatment ,Infarction ,Brain Edema ,Basal Ganglia ,Autologous blood injection ,Central nervous system disease ,Blood Transfusion, Autologous ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,medicine ,Animals ,cardiovascular diseases ,030212 general & internal medicine ,Rats, Wistar ,Cerebral Hemorrhage ,Intracerebral hemorrhage ,Vascular disease ,business.industry ,Skull ,Brain ,Decompression, Surgical ,medicine.disease ,Magnetic Resonance Imaging ,Rats ,nervous system diseases ,3. Good health ,Surgery ,Disease Models, Animal ,Treatment Outcome ,Anesthesia ,Decompressive craniectomy ,Neurology (clinical) ,Intracranial Hypertension ,business ,Craniotomy ,030217 neurology & neurosurgery - Abstract
OBJECTIVE: Intracerebral hemorrhage (ICH) has a high mortality rate and leaves most survivors disabled. The dismal outcome is mostly due to the mass effect of hematoma plus edema. Major clinical trials show no benefit from surgical or medical treatment. Decompressive craniectomy has, however, proven beneficial for large ischemic brain infarction with massive swelling. We hypothesized that craniectomy can improve ICH outcome as well. METHODS: We used the model of autologous blood injection into the basal ganglia in rats. After induction of ICH and then magnetic resonance imaging, animals were randomly allocated to groups representing no craniectomy (n = 10) or to craniectomy at 1, 6, or 24 hours. A fifth group without ICH underwent craniectomy only. Neurological and behavioral outcomes were assessed on days 1, 3, and 7 after ICH induction. Furthermore, terminal deoxynucleotidyl transferase dUTP nick-end labeling-positive cells were counted. RESULTS: After 7 days, compared with the ICH + no craniectomy group, all craniectomy groups had strikingly lower mortality (P < 0.01), much better neurological outcome (P < 0.001), and more favorable behavioral outcome. A trend occurred in the ICH + no craniectomy group toward more robust apoptosis. CONCLUSION: Decompressive craniectomy performed up to 24 hours improved outcome after experimental ICH, with earlier intervention of greater benefit.
- Published
- 2009