title: Neuroprotective effects of hemicraniectomy in malignant middle cerebral artery infarctions: experimental study.
abstract: BACKGROUND
  Despite optimal medical therapy the mortality rate approaches 50% in MCA infarctions. Although recent studies have been showed life-saving effect of hemicraniectomy; there are a few data available in regard to neuroprotection effect of decompressive craniectomy (DC). We induced a malignant cerebral ischemia model by intraluminal permanent middle cerebral artery occlusion (MCAo) in male rats for defining the neuroprotective effects of early DC on brain-blood barrier (BBB) molecular changes, infarct size and cerebral edema.
  
  
  METHODS
  A total of 48 male Spraque-Dawley rats were allocated to 4 groups; sham (N.=9), control (N.=9), experiment 1 (N.=15), experiment 2 (N.=15). DC was performed by creating a bone flap, after MCAo at 4 and 24 hours. After 28 hours of survival, all animals were sacrificed. Infarction volumes were calculated from TTC (2,3,5-triphenyl-2H-tetrazolium chloride)-stained brain sections. In all groups, cerebral edema was quantified as a change in the percentage of brain water content. Western Blot was used to analyze the expression of tight junction protein claudin-5 and occludin.
  
  
  RESULTS
  Brain water content was calculated 75.18±0.75% in the early DC group and 77.76±0.71% in the late DC group. No significant difference was found between experiment groups (P=0.178). In the early DC group; occludin and claudin-5 were significantly expressed at higher levels compared to late DC group (occluding, P=0.013; claudin-5, P=0.034). At early DC group (73.38±23.11 mm3) the final infarct volumes were significantly smaller than in the late DC group (377.18±39.23 mm3) (P=0.013).
  
  
  CONCLUSIONS
  The study results supported the neuroprotective effects of early DC in malignant MCA infarcts.
authors.affiliation: Department of Neurology, Faculty of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey - dr.ozgealtintas@gmail.com.
authors.forename: Ozge
authors.initials: O
authors.lastname: Altintas
authors.affiliation: Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Veysel
authors.initials: V
authors.lastname: Antar
authors.affiliation: Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Oguz
authors.initials: O
authors.lastname: Baran
authors.affiliation: Department of Biochemistry, Faculty of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey.
authors.forename: Ersin
authors.initials: E
authors.lastname: Karatas
authors.affiliation: Department of Medical Biology, Istanbul Medipol University, Istanbul, Turkey.
authors.forename: Mehmet Ozgen
authors.initials: MO
authors.lastname: Altintas
authors.affiliation: Department of Biochemistry, Faculty of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey.
authors.forename: Sidika
authors.initials: S
authors.lastname: Kesgin
authors.affiliation: Department of Pathology, Faculty of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey.
authors.forename: Nur
authors.initials: N
authors.lastname: Buyukpinarbasili
authors.affiliation: Department of Biochemistry, Faculty of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey.
authors.forename: Abdurrahim
authors.initials: A
authors.lastname: Kocyigit
authors.affiliation: Department of Neurology, Faculty of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey.
authors.forename: Talip
authors.initials: T
authors.lastname: Asil
mesh_terms: D000818:Animals; D001812:Blood-Brain Barrier / Q000473:pathology*; D001921:Brain / Q000601:surgery; D001929:Brain Edema / Q000601:surgery*; D002545:Brain Ischemia / Q000601:surgery; D056424:Decompressive Craniectomy / Q000379:methods; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery*; D008297:Male; D018696:Neuroprotective Agents / Q000494:pharmacology*; D051381:Rats
chemical_list: D018696:Neuroprotective Agents