Jaechan Park1, Jong-Heon Kim2, Kyoungho Suk2, Hyung Soo Han3, Boram Ohk4, Dong Gyu Kim5. 1. Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: jparkmd@hotmail.com. 2. Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. 3. Department of Physiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. 4. Clinical Trial Center, Kyungpook National University Hospital, Daegu, Republic of Korea. 5. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: jparkneurosurgery@gmail.com.
Abstract
OBJECTIVE: To evaluate the combined effects of a decompressive craniectomy and prolonged selective brain hypothermia on large hemispheric infarction in a rat model. METHODS: Permanent middle cerebral artery infarction using an endovascular occlusion technique was created in rats assigned to 4 groups. Normothermia was maintained without a craniectomy in group A (n = 20) as the control, prolonged (>44 hours), selective brain hypothermic treatment was performed on group B (n = 20), a craniectomy was performed on group C (n = 18), and prolonged, selective brain hypothermic treatment using a cooling coil implanted in the craniectomy site was combined with a craniectomy for group D (n = 18). RESULTS: Group B and C exhibited a significantly reduced infarct volume when compared with the control. Furthermore, group D showed a significantly reduced infarct volume when compared with group C, plus a significantly improved neurologic score. These results for group D were associated with an increased neuronal cell count and reduced hyperactive microglia and hypertrophic astrocytes in the cortical penumbra (P < 0.01). Moreover, a greater preservation of normal-appearing axonal bundles and the blood-brain barrier was observed in the core infarct region at the caudoputamen. CONCLUSIONS: A decompressive craniectomy reduced the infarct volume and improved the neurologic outcomes in a rat model of middle cerebral artery infarction. Furthermore, when combined with prolonged selective brain hypothermia, significant additional benefits were observed for the neurologic outcomes, infarct volume, and degree of neuroinflammation.
OBJECTIVE: To evaluate the combined effects of a decompressive craniectomy and prolonged selective brain hypothermia on large hemispheric infarction in a rat model. METHODS: Permanent middle cerebral artery infarction using an endovascular occlusion technique was created in rats assigned to 4 groups. Normothermia was maintained without a craniectomy in group A (n = 20) as the control, prolonged (>44 hours), selective brain hypothermic treatment was performed on group B (n = 20), a craniectomy was performed on group C (n = 18), and prolonged, selective brain hypothermic treatment using a cooling coil implanted in the craniectomy site was combined with a craniectomy for group D (n = 18). RESULTS: Group B and C exhibited a significantly reduced infarct volume when compared with the control. Furthermore, group D showed a significantly reduced infarct volume when compared with group C, plus a significantly improved neurologic score. These results for group D were associated with an increased neuronal cell count and reduced hyperactive microglia and hypertrophic astrocytes in the cortical penumbra (P < 0.01). Moreover, a greater preservation of normal-appearing axonal bundles and the blood-brain barrier was observed in the core infarct region at the caudoputamen. CONCLUSIONS: A decompressive craniectomy reduced the infarct volume and improved the neurologic outcomes in a rat model of middle cerebral artery infarction. Furthermore, when combined with prolonged selective brain hypothermia, significant additional benefits were observed for the neurologic outcomes, infarct volume, and degree of neuroinflammation.