The Effects of Selective Brain Hypothermia and Decompressive Craniectomy on Brain Edema After Closed Head Injury in Mice
Intractable brain edema remains one of the main causes of death after traumatic brain injury (TBI). Brain hypothermia and decompressive craniectomy have been considered as potential therapies. The goal of our experimental study was to determine if selecti
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Abstract Intractable brain edema remains one of the main causes of death after traumatic brain injury (TBI). Brain hypothermia and decompressive craniectomy have been considered as potential therapies. The goal of our experimental study was to determine if selective hypothermia in combination with craniectomy could modify the development of posttraumatic brain edema. Male CD-1 mice were anesthetized with halothane and randomly assigned into the following groups: sham-operated (n = 5), closed head injury (CHI) alone (n = 5), CHI followed by craniectomy at 1 h post-TBI (n = 5) and CHI + craniectomy and selective hypothermia (focal brain cooling using cryosurgery device) maintained for 5 h (n = 5). Animals were sacrificed at 7 h posttrauma and brains were removed, sagittally dissected and dried. The brain water content of separate hemispheres was calculated from the weight difference before and after drying. In the CHI alone group there was no significant increase in brain water content in both the ipsi- and contralateral hemispheres (80.59 ± 1% and 78.74 ± 0.9% in the CHI group vs. 79.31 ± 0.7% and 79.01 ± 0.3% in the sham group, respectively). Brain edema was significantly increased ipsilaterally in the trauma + craniectomy group (82.11 ± 0.6%, p 0.05) as compared to the sham group (79.31 ± 0.7%). These data suggest that decompressive craniectomy leads to an increase in brain water content after CHI. Additional focal hypothermia may be an effective approach in the treatment of posttraumatic brain edema. Keywords Traumatic brain injury • closed head injury • brain edema • selective brain cooling • hypothermia • decompressive craniectomy • mice
J. Szczygielski (), A.E. Mautes, K. Schwerdtfeger, and W.I. Steudel Department of Neurosurgery, Saarland University Hospital, Kirrberger Straße, Homburg, Saar, Germany e-mail: [email protected]
Introduction Traumatic Brain Injury (TBI) is considered a major cause of death and disability among individuals at productive ages in developed countries (4). One of the fatal consequences of brain trauma is an intractable increase in intracranial pressure (ICP) due to refractory brain edema (3). To date, the multiple methods of treatment of uncontrolled posttraumatic increases in ICP have been tested both experimentally and clinically. These methods include controlled hyperventilation, infusion of hypertonic solutions, pharmacological suppression of cerebral metabolism, hypothermia and decompressive craniectomy (DC) (1,15,32). The last two methods bear the most interesting and controversial potential for therapeutic use. Although both treatment modes – DC and brain hypothermia – have already been used separately in clinical practice, little information is available about a potential synergistic effect of these two methods. The purpose of this study was to analyze the effect of combined treatment of DC and hypothermia on the development of posttraumatic brain edema in a mouse model of closed head injury.
Methods Male CD-1 mice were used in this study, and the followin
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