Document Detail

Decompressive craniectomy for intracerebral hemorrhage.
MedLine Citation:
PMID:  19834384     Owner:  NLM     Status:  MEDLINE    
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.
Ivan Marinkovic; Daniel Strbian; Eric Pedrono; Olga Y Vekovischeva; Shashank Shekhar; Aysan Durukan; Esa R Korpi; Usama Abo-Ramadan; Turgut Tatlisumak
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurosurgery     Volume:  65     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2010-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  780-6, 1 p following 786; discussion 786     Citation Subset:  IM    
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
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MeSH Terms
Basal Ganglia / blood supply,  pathology,  physiopathology
Blood Transfusion, Autologous / adverse effects
Brain / blood supply,  pathology,  physiopathology
Brain Edema / etiology,  physiopathology,  therapy*
Cerebral Hemorrhage / complications,  physiopathology,  therapy*
Craniotomy / methods*
Decompression, Surgical / methods*
Disease Models, Animal
Intracranial Hypertension / etiology,  physiopathology,  surgery*
Magnetic Resonance Imaging
Rats, Wistar
Skull / surgery
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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