Artikel
Effects of selective brain hypothermia and decompressive craniectomy on neurological outcome after closed head injury in mice
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Autoren
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J. Szczygielski
- Klinik für Neurochirurgie, Universitätskliniken des Saarlandes, Homburg/Saar
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A.E. Mautes
- Klinik für Neurochirurgie, Universitätskliniken des Saarlandes, Homburg/Saar
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A. Müller
- Klinik für Radiologie, Universitätskliniken des Saarlandes, Homburg/Saar
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C. Sippl
- Klinik für Neurochirurgie, Universitätskliniken des Saarlandes, Homburg/Saar
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K. Schwerdtfeger
- Klinik für Neurochirurgie, Universitätskliniken des Saarlandes, Homburg/Saar
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W.I. Steudel
- Klinik für Neurochirurgie, Universitätskliniken des Saarlandes, Homburg/Saar
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J. Oertel
- Klinik für Neurochirurgie, Universitätskliniken des Saarlandes, Homburg/Saar
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Both hypothermia and decompressive craniectomy have been proposed as treatment of severe traumatic brain injury. Results of some recent clinical trials suggested lack of neurological improvement after decompressive craniectomy The goal of our experiment was to determine whether the selective brain hypothermia could impact the effect of craniectomy after brain trauma.
Methods: Male CD-1 mice were randomly assigned into the following groups (n=8 each): sham, decompressive craniectomy (DC), closed head injury (CHI), CHI followed by craniectomy (CHI+DC) and CHI and DC followed by focal hypothermia (CHI+DC+H). At 24 h posttrauma animals were subjected to Neurological Severity Score (NSS) test and Beam Balance Score (BBS) test. The neurological outcome was specified as impairment score for NSS (0–10 points) and BBS (0–5 points). One-way ANOVA was used for statistical analysis.
Results: According to NSS there was a significant impairment among all the groups subjected to trauma (CHI: 4.63±2.06, p < 0.01; CHI+DC: 6.84±2.1, p < 0.001; CHI+DC+H: 4.41±1.8, p < 0.05) when compared to sham animals (1.38±0.52). The animals subjected to both trauma and craniectomy performed significantly worse (CHI+DC: 6.84±2.1, p < 0.001) than animals with craniectomy alone (DC: 2.71±1.51). This deleterious effect disappeared when additional hypothermia was applied (CHI+DC+H: 4.41±1.8, ns). BBS was significantly worse in CHI group (2.33±1.35, p < 0.05) and in CHI+DC group (2.63±1.53, p < 0.05) but not in CHI+DC+H group (1.5±1.41, p > 0.05) when compared to the sham group (0.67±0.47).
Conclusions: There was synergistic deleterious effect of mechanical and surgical trauma consistent with results of recent clinical trials reporting, that early decompressive craniectomy was associated with more unfavorable outcomes. Selective brain cooling applied after trauma and craniectomy effaced the negative effect of additional surgical trauma on neurological function. Therefore the local hypothermia may be a very promising alternative to complication-burdened systemic hypothermia. The potential of this treatment option should be explored in clinical feasibility study.
