Doerfler A, Forsting M, Reith W, Staff C, Heiland S, Schäbitz W R, von Kummer R, Hacke W, Sartor K
Department of Neuroradiology, University of Heidelberg Medical School, Germany.
J Neurosurg. 1996 Nov;85(5):853-9. doi: 10.3171/jns.1996.85.5.0853.
Acute ischemia in the complete territory of the carotid artery may lead to massive cerebral edema with raised intracranial pressure and progression to coma and death due to uncal, cingulate, or tonsillar herniation. Although clinical data suggest that patients benefit from undergoing decompressive surgery for acute ischemia, little data about the effect of this procedure on experimental ischemia are available. In this article the authors present results of an experimental study on the effects of decompressive craniectomy performed at various time points after endovascular middle cerebral artery (MCA) occlusion in rats. Focal cerebral ischemia was induced in 68 rats using an endovascular occlusion technique focused on the MCA. Decompressive craniectomy was performed in 48 animals (in groups of 12 rats each) 4, 12, 24, or 36 hours after vessel occlusion. Twenty animals (control group) were not treated by decompressive craniectomy. The authors used the infarct volume and neurological performance at Day 7 as study endpoints. Although the mortality rate in the untreated group was 35%, none of the animals treated by decompressive craniectomy died (mortality 0%). Neurological behavior was significantly better in all animals treated by decompressive craniectomy, regardless of whether they were treated early or late. Neurological behavior and infarction size were significantly better in animals treated very early by decompressive craniectomy (4 hours) after endovascular MCA occlusion (p < 0.01); surgery performed at later time points did not significantly reduce infarction size. The results suggest that use of decompressive craniectomy in treating cerebral ischemia reduces mortality and significantly improves outcome. If performed early after vessel occlusion, it also significantly reduces infarction size. By performing decompressive craniectomy neurosurgeons will play a major role in the management of stroke patients.
颈动脉供血区域的急性缺血可能导致严重的脑水肿，颅内压升高，并因钩回、扣带回或小脑扁桃体疝而进展为昏迷和死亡。尽管临床数据表明，急性缺血患者可从减压手术中获益，但关于该手术对实验性缺血影响的数据却很少。在本文中，作者展示了一项实验研究的结果，该研究针对大鼠大脑中动脉（MCA）血管内闭塞后不同时间点进行减压颅骨切除术的效果。使用聚焦于MCA的血管内闭塞技术，在68只大鼠中诱导局灶性脑缺血。在血管闭塞后4、12、24或36小时，对48只动物（每组12只大鼠）进行减压颅骨切除术。20只动物（对照组）未接受减压颅骨切除术治疗。作者将第7天的梗死体积和神经功能作为研究终点。尽管未治疗组的死亡率为35%，但接受减压颅骨切除术治疗的动物均未死亡（死亡率为0%）。无论治疗时间早晚，所有接受减压颅骨切除术治疗的动物神经行为均明显更好。在血管内MCA闭塞后极早期（4小时）接受减压颅骨切除术治疗的动物，神经行为和梗死面积明显更好（p<0.01）；在较晚时间点进行的手术并未显著减小梗死面积。结果表明，减压颅骨切除术用于治疗脑缺血可降低死亡率并显著改善预后。如果在血管闭塞后早期进行，还可显著减小梗死面积。通过实施减压颅骨切除术，神经外科医生将在中风患者的治疗中发挥重要作用。
