From the Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research, University of Munich Medical Center, Munich, Germany (D.B., S.A., K.S., N.P.); and Munich Cluster for Systems Neurology (Synergy), Munich, Germany (N.P.).
Stroke. 2015 Mar;46(3):819-26. doi: 10.1161/STROKEAHA.114.007703. Epub 2015 Jan 15.
Elevated intracranial pressure (ICP) is a key feature of subarachnoid hemorrhage (SAH). Here, we examined the role of elevated ICP in the pathophysiology of SAH, and we investigated whether decreasing ICP by performing decompressive craniectomy (DC) can improve outcome.
SAH was induced in male C57BL/6 mice via endovascular Circle of Willis perforation in the following 4 groups: sham surgery, SAH, DC after SAH, and DC before SAH. DC was performed either 15 minutes before or after SAH induction. ICP, cerebral blood flow, heart rate, oxygen saturation, and end-tidal PCO2 were monitored for 45 minutes. After surgery, neurological function was evaluated daily for 7 days. After killing, hippocampal neurons, corpus callosum thickness, and ventricular volume were evaluated on paraformaldehyde-fixed coronal brain sections.
Although DC reduced SAH-induced ICP, it yielded no beneficial effect with respect to posthemorrhagic hypoperfusion; moreover, DC increased the incidence of rebleeding, induced more severe neurological impairments, and caused higher mortality. Post SAH, mice that survived 7 days had no histopathologic differences, regardless of whether DC was performed.
Performing DC to reduce ICP either during or acutely after SAH resulted in more severe bleeding, a higher incidence of rebleeding, and poorer outcome. Thus, elevated post-hemorrhagic ICP plays an important role in controlling bleeding after SAH and should therefore not be reduced acutely. If DC is considered for treating a patient with SAH, the timing of decompression should take these effects into consideration.
颅内压升高（ICP）是蛛网膜下腔出血（SAH）的一个关键特征。在这里，我们研究了 ICP 升高在 SAH 病理生理学中的作用，并研究了通过施行去骨瓣减压术（DC）降低 ICP 是否可以改善预后。
通过血管内 Willis 环穿孔在雄性 C57BL/6 小鼠中诱导 SAH，随后在以下 4 组中进行研究：假手术组、SAH 组、SAH 后 DC 组和 SAH 前 DC 组。在 SAH 诱导前 15 分钟或后施行 DC。监测 ICP、脑血流、心率、氧饱和度和呼气末 PCO2 45 分钟。手术后，每天评估神经功能 7 天。杀死后，在多聚甲醛固定的冠状脑切片上评估海马神经元、胼胝体厚度和脑室体积。
尽管 DC 降低了 SAH 诱导的 ICP，但对出血后低灌注没有有益作用；此外，DC 增加了再出血的发生率，导致更严重的神经功能障碍和更高的死亡率。在 SAH 后，无论是否进行 DC，存活 7 天的小鼠均无组织病理学差异。
在 SAH 期间或急性后施行 DC 以降低 ICP 会导致更严重的出血、更高的再出血发生率和更差的预后。因此，出血后升高的 ICP 在控制 SAH 后的出血方面起着重要作用，因此不应急性降低。如果考虑对 SAH 患者施行 DC，减压的时机应考虑到这些影响。
