Szczygielski Jacek, Mautes Angelika E, Müller Andreas, Sippl Christoph, Glameanu Cosmin, Schwerdtfeger Karsten, Steudel Wolf-Ingo, Oertel Joachim
1 Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine , Homburg/Saar, Germany .
2 Department of Radiology, Saarland University Medical Center and Saarland University Faculty of Medicine , Homburg/Saar, Germany .
J Neurotrauma. 2016 Jan 1;33(1):122-31. doi: 10.1089/neu.2014.3835. Epub 2015 Aug 28.
Decompressive craniectomy has been widely used in patients with head trauma. The randomized clinical trial on an early decompression (DECRA) demonstrated that craniectomy did not improve the neurological outcome, in contrast to previous animal experiments. The goal of our study was to analyze the effect of decompressive craniectomy in a murine model of head injury. Male mice were assigned into the following groups: sham, decompressive craniectomy, closed head injury (CHI), and CHI followed by craniectomy. At 24 h post-trauma, animals underwent the Neurological Severity Score test (NSS) and Beam Balance Score test (BBS). At the same time point, magnetic resonance imaging was performed, and volume of edema and contusion was assessed, followed by histopathological analysis. According to NSS, animals undergoing both trauma and craniectomy presented the most severe neurological impairment. Also, balancing time was reduced in this group compared with sham animals. Both edema and contusion volume were increased in the trauma and craniectomy group compared with sham animals. Histopathological analysis showed that all animals that underwent trauma presented substantial neuronal loss. In animals treated with craniectomy after trauma, a massive increase of edema with hemorrhagic transformation of contusion was documented. Decompressive craniectomy applied after closed head injury in mice leads to additional structural and functional impairment. The surgical decompression via craniectomy promotes brain edema formation and contusional blossoming in our model. This additive effect of combined mechanical and surgical trauma may explain the results of the DECRA trial and should be explored further in experiments.
减压性颅骨切除术已广泛应用于头部外伤患者。一项关于早期减压（DECRA）的随机临床试验表明，与先前的动物实验相反，颅骨切除术并未改善神经功能结局。我们研究的目的是分析减压性颅骨切除术在小鼠头部损伤模型中的作用。雄性小鼠被分为以下几组：假手术组、减压性颅骨切除组、闭合性颅脑损伤（CHI）组以及CHI后颅骨切除组。在创伤后24小时，对动物进行神经严重程度评分测试（NSS）和光束平衡评分测试（BBS）。在同一时间点，进行磁共振成像，评估水肿和挫伤体积，随后进行组织病理学分析。根据NSS，同时接受创伤和颅骨切除术的动物出现了最严重的神经功能损害。此外，与假手术组动物相比，该组的平衡时间缩短。与假手术组动物相比，创伤和颅骨切除组的水肿和挫伤体积均增加。组织病理学分析表明，所有遭受创伤的动物均出现大量神经元丢失。在创伤后接受颅骨切除术的动物中，记录到水肿大量增加且挫伤有出血性转化。小鼠闭合性颅脑损伤后应用减压性颅骨切除术会导致额外的结构和功能损害。在我们的模型中，通过颅骨切除术进行的手术减压会促进脑水肿形成和挫伤扩大。机械性和手术性创伤联合产生的这种累加效应可能解释了DECRA试验的结果，应在实验中进一步探索。
