Article
Diverse effect of acetazolamide administration in murine Close Head Injury with versus without surgical decompression
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Authors
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Jacek Szczygielski
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg / Saar, Deutschland
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Vanessa Hubertus
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg / Saar, Deutschland
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Eduard Kruchten
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg / Saar, Deutschland
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Andreas Müller
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg / Saar, Deutschland
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Joachim Oertel
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg / Saar, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Acetazolamide, a carbonic anhydrase inhibitor, is widely used in neurosurgical practice for treatment of hydrocephalus and benign intracranial hypertension. However, its administration in head trauma patients is not recommended due to the vasodilatation properties of acetazolamide: according to Monro-Kellie doctrine, the subsequent increase in volume of intracranial blood may lead to uncontrolled raise of ICP. We hypothesized, that this potentially negative effect of acetazolamide after head injury will be reduced in the condition of surgically opened cranial vault (decompressive craniectomy). To test this hypothesis, a murine model of closed head injury has been used.
Methods: Anesthetized male CD-1 mice were randomly assigned into the one of the following experimental groups: sham procedure, decompressive craniectomy alone, closed head injury alone, closed head injury followed by craniectomy at 1h posttrauma and closed head injury with craniectomy followed by intraperitoneal administration of acetazolamide (n=10 each group). After the surgery, the neurological function was assessed according to Neurological Severity Score (NSS) and Beam Balance Score 24h and 72h after head injury. The neurological impairment scores were compared between groups using one-way ANOVA. Significance was set at p < 0.05.
Results: The neurological assesement revealed a significant impairment in animals treated with acetazolamide without decompressive craniectomy, according to NSS, BB and according to balancing time. This negative effect was present during the 24h posttrauma and partially improved at 72h posttrauma, as compared to the sham animals. In contrast, in animals treated by surgical decompression before administration of the acetazolamide, no significant difference in neurological performance (compared with sham animals) could be documented.
Conclusion: The action of acetazolamide on posttraumatic outcome differs between animals with and without craniectomy. Possibly, the removal of cranial vault enables the acetalozamide-induced increase in brain volume to expand outside the rigid cranium. This observation should be further investigated in both experimental and clinical condition, in order to test possible new indication for the use of acetazolamide.
