Decompressive craniectomy for intracerebral hemorrhage.
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.


CONCLUSIONS
Decompressive craniectomy performed up to 24 hours improved outcome after experimental ICH, with earlier intervention of greater benefit.
Marinkovic
Ivan
I
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
Strbian
Daniel
D
Pedrono
Eric
E
Vekovischeva
Olga Y
OY
Shekhar
Shashank
S
Durukan
Aysan
A
Korpi
Esa R
ER
Abo-Ramadan
Usama
U
Tatlisumak
Turgut
T
D000818:Animals; D001479:Basal Ganglia / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D004195:Disease Models, Animal; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D012886:Skull / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome