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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Effect of decompressive craniectomy for treatment of ICH in an animal model

Meeting Abstract

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  • Patrick Schiebel - Neurochirurgische Universitätsklinik Heidelberg
  • Renan Sanchez - Neurochirurgische Universitätsklinik Heidelberg
  • Edgar Santos - Neurochirurgische Universitätsklinik Heidelberg
  • Michael Schöll - Neurochirurgische Universitätsklinik Heidelberg
  • Oliver Sakowitz - Neurochirurgische Universitätsklinik Heidelberg
  • Modar Kentar - Neurochirurgische Universitätsklinik Heidelberg
  • Berk Orakcioglu - Neurochirurgische Universitätsklinik Heidelberg
  • Andreas Unterberg - Neurochirurgische Universitätsklinik Heidelberg

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 117

doi: 10.3205/14dgnc513, urn:nbn:de:0183-14dgnc5136

Published: May 13, 2014

© 2014 Schiebel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Classical surgical therapy of ICH (i.e. haematoma evacuation) remains controversial, following the results of the STICH study. Decompressive hemicraniectomy (DC) prove beneficial results in cases of malignant middle cerebral artery infarction. First clinical studies suggested that DC may be a promising treatment option for ICH, too. To test the hypothesis of beneficial treatment effects of DC in ICH we used a multimodal monitoring approach in porcine ICH.

Method: We investigated the effect of DC for ICH treatment in an animal model with 6 pigs. Beyond vital signs (RR, HF, sPO2, CO2 exsp, BGA, etc.), multimodal monitoring (ICP, pTO2, micro dialysis (Glutamate, pyruvate, lactate, glucose), CBF) of the perihaemorrhagic zone was performed. Monitoring duration was 12 hours.

Results: DC showed significant long-term reduction of ICP from 12 to 5mmHg. After ICH pTO2 was continuously decreasing. There was also a significant but only temporary improvement of pTO2 from 9 to 13mmHg. This means the continuously decrement of pTO2 after DC was delayed for one hour. There was no long-term improvement from DC on pTO2. Micro dialysis values only showed temporary improvements on the perihaemorrhagic zone comparable to the pTO2 effect.

Conclusions: After experimental ICH DC did improve ICP. PTO2 and metabolism in the perihemorrhagic zone showed only short-time improvement after DC. Short-term improvements of pTO2 and metabolism of the perihemorrhagic zone are disappointing. However, if DC is an useful treatment in ICH further investigations have to be done.