title: Effect of decompressive craniectomy on outcome following subarachnoid hemorrhage in mice.
abstract: OBJECTIVE
  Elevated intracranial pressure (ICP) is a key feature of subarachnoid hemorrhage (SAH). Here, we examined the role of elevated ICP in the pathophysiology of SAH, and we investigated whether decreasing ICP by performing decompressive craniectomy (DC) can improve outcome.
  
  
  METHODS
  SAH was induced in male C57BL/6 mice via endovascular Circle of Willis perforation in the following 4 groups: sham surgery, SAH, DC after SAH, and DC before SAH. DC was performed either 15 minutes before or after SAH induction. ICP, cerebral blood flow, heart rate, oxygen saturation, and end-tidal PCO2 were monitored for 45 minutes. After surgery, neurological function was evaluated daily for 7 days. After killing, hippocampal neurons, corpus callosum thickness, and ventricular volume were evaluated on paraformaldehyde-fixed coronal brain sections.
  
  
  RESULTS
  Although DC reduced SAH-induced ICP, it yielded no beneficial effect with respect to posthemorrhagic hypoperfusion; moreover, DC increased the incidence of rebleeding, induced more severe neurological impairments, and caused higher mortality. Post SAH, mice that survived 7 days had no histopathologic differences, regardless of whether DC was performed.
  
  
  CONCLUSIONS
  Performing DC to reduce ICP either during or acutely after SAH resulted in more severe bleeding, a higher incidence of rebleeding, and poorer outcome. Thus, elevated post-hemorrhagic ICP plays an important role in controlling bleeding after SAH and should therefore not be reduced acutely. If DC is considered for treating a patient with SAH, the timing of decompression should take these effects into consideration.
authors.affiliation: From the Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research, University of Munich Medical Center, Munich, Germany (D.B., S.A., K.S., N.P.); and Munich Cluster for Systems Neurology (Synergy), Munich, Germany (N.P.).
authors.forename: Dominik
authors.initials: D
authors.lastname: Bühler
authors.affiliation: From the Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research, University of Munich Medical Center, Munich, Germany (D.B., S.A., K.S., N.P.); and Munich Cluster for Systems Neurology (Synergy), Munich, Germany (N.P.).
authors.forename: Sepiede
authors.initials: S
authors.lastname: Azghandi
authors.affiliation: From the Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research, University of Munich Medical Center, Munich, Germany (D.B., S.A., K.S., N.P.); and Munich Cluster for Systems Neurology (Synergy), Munich, Germany (N.P.).
authors.forename: Kathrin
authors.initials: K
authors.lastname: Schüller
authors.affiliation: From the Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research, University of Munich Medical Center, Munich, Germany (D.B., S.A., K.S., N.P.); and Munich Cluster for Systems Neurology (Synergy), Munich, Germany (N.P.). nikolaus.plesnila@med.uni-muenchen.de.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Plesnila
mesh_terms: D000818:Animals; D001835:Body Weight; D002560:Cerebrovascular Circulation / Q000502:physiology; D056424:Decompressive Craniectomy; D006849:Hydrocephalus / Q000503:physiopathology; D019586:Intracranial Hypertension; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D008991:Monitoring, Physiologic; D010477:Perfusion; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D066127:White Matter / Q000473:pathology
keywords: decompressive craniectomy; intracranial pressure; mouse model; subarachnoid hemorrhage