Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
J Neurotrauma. 2011 Feb;28(2):237-43. doi: 10.1089/neu.2010.1443.
Decompressive craniectomy is one therapeutic option for severe traumatic brain injury (TBI), and it has long been used for the treatment of patients with malignant post-traumatic brain edema. A lack of definitive evidence, however, prevents physicians from drawing any conclusions about the effects of decompressive craniectomy for the treatment of TBI. Therefore, the aim of the present study was to investigate the influence of decompressive craniectomy on post-traumatic brain edema formation. The aquaporin-4 (AQP4) water channel is predominantly expressed in astrocytes, and it plays an important role in the regulation of brain water homeostasis. In the present study, we investigated the time course of AQP4 expression and the water content of traumatized cortex following decompressive craniectomy after TBI. Adult male Sprague-Dawley rats (300-400 g) were subjected to lateral fluid percussion injury using the Dragonfly device. The effect of decompressive craniectomy was studied in traumatized rats without craniectomy (closed skull, DC-), and in rats craniectomized immediately after trauma (DC+). AQP4 expression was investigated with a Western blot analysis and immunohistochemistry. Brain edema was measured using the wet weight/dry weight method. At 48 h after TBI, AQP4 expression of the DC- group was significantly increased compared with the DC+ group (p < 0.01). In addition, the cortical water content of the DC- group was significantly increased compared to the DC+ group at the same time point (p < 0.05). The present results suggest that decompressive craniectomy may affect AQP4 expression and reduce brain edema formation after TBI.
去骨瓣减压术是治疗严重创伤性脑损伤（TBI）的一种治疗选择，长期以来一直用于治疗恶性创伤后脑水肿患者。然而，缺乏明确的证据使得医生无法对去骨瓣减压术治疗 TBI 的效果得出任何结论。因此，本研究旨在探讨去骨瓣减压术对创伤后脑水肿形成的影响。水通道蛋白-4（AQP4）水通道主要在星形胶质细胞中表达，在调节脑水稳态中起重要作用。在本研究中，我们研究了 TBI 后去骨瓣减压术对创伤性皮质 AQP4 表达和水含量的时间进程。成年雄性 Sprague-Dawley 大鼠（300-400g）使用 Dragonfly 装置进行侧方液压冲击伤。研究了未行去骨瓣减压术的创伤大鼠（闭合颅骨，DC-）和创伤后立即行去骨瓣减压术的大鼠（DC+）的去骨瓣减压术效果。通过 Western blot 分析和免疫组织化学法研究 AQP4 表达。采用湿重/干重法测量脑水肿。TBI 后 48h，DC-组 AQP4 表达明显高于 DC+组（p<0.01）。此外，同一时间点 DC-组皮质水含量明显高于 DC+组（p<0.05）。本研究结果表明，去骨瓣减压术可能影响 TBI 后 AQP4 的表达，减少脑水肿的形成。
