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Decompressive craniectomy for intracerebral hemorrhage
Ivan Marinkovic1, Daniel Strbian, Eric Pedrono
1Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
Insights
Decompressive craniectomy significantly reduced mortality and improved neurological and behavioral outcomes in rats with intracerebral hemorrhage (ICH). Early surgical intervention up to 24 hours post-ICH showed greater benefits in this experimental study.
Area of Science:
- Neurosurgery
- Neurology
- Experimental Medicine
Background:
- Intracerebral hemorrhage (ICH) has poor outcomes, with high mortality and disability.
- Current treatments for ICH show limited benefit.
- Decompressive craniectomy is effective for ischemic stroke with swelling.
Purpose of the Study:
- To investigate the efficacy of decompressive craniectomy in improving outcomes after experimental intracerebral hemorrhage.
- To test the hypothesis that craniectomy can mitigate the adverse effects of hematoma and edema in ICH.
Main Methods:
- An experimental model of intracerebral hemorrhage was induced in rats via autologous blood injection into the basal ganglia.
- Animals underwent decompressive craniectomy at 1, 6, or 24 hours post-ICH, or received no craniectomy.
- Neurological, behavioral, and apoptosis assessments were performed.
Main Results:
- All decompressive craniectomy groups exhibited significantly lower mortality rates compared to the no-craniectomy group (P < 0.01).
- Neurological and behavioral outcomes were substantially improved in craniectomy groups (P < 0.001).
- A trend towards increased apoptosis was observed in the non-treated ICH group.
Conclusions:
- Decompressive craniectomy performed up to 24 hours after experimental ICH significantly improved survival and functional outcomes.
- Earlier intervention with decompressive craniectomy yielded greater benefits.
- This study supports the potential of decompressive craniectomy as a therapeutic option for ICH.
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.
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