Abstract
Decompressive hemicraniectomy (DHC) significantly reduces mortality in patients with large hemispheric ischemic strokes but has not been studied in intracranial hemorrhage (ICH). Male Sabra mice were subjected to large experimental ICH. The animals then underwent DHC or sham surgery. Early (1 day post-op) and late (5 days post-op) mortality rates and neurological disability were monitored. The animals were perfusion-fixed at 5 days post-ICH induction, and their brains were studied for hematoma volume and presence of active caspase 3 as a measure of apoptotic death in the area surrounding the hematoma. Our results show that DHC significantly reduced early (7 vs. 75 %, p < 0.001) and late (46 vs. 83 %, p = 0.017) mortality after large ICH. No significant differences in neurological disability were observed between surviving animals in both groups. Hematoma volumes did not differ between the groups on histological evaluation. The number of active caspase 3-positive neurons at the hematoma boundary was significantly higher in animals that underwent DHC. In conclusion, DHC reduces early and late mortality after devastating ICH without changing the hematoma volumes and without notable effects on motor and sensory functions in survivors. Further evaluation of this method to reduce mortality in ICH patients is warranted.
Similar content being viewed by others
References
Adeoye O, Broderick JP (2010) Advances in the management of intracerebral hemorrhage. Nat Rev Neurol 6:593–601
Avraham Y, Davidi N, Porat M, Chernoguz D, Magen I, Vorobeiv L, Berry EM, Leker RR (2010) Leptin reduces infarct size in association with enhanced expression of CB2, TRPV1, SIRT-1 and leptin receptor. Curr Neurovasc Res 7:136–143
Berrouschot J, Rother J, Glahn J, Kucinski T, Fiehler J, Thomalla G (2005) Outcome and severe hemorrhagic complications of intravenous thrombolysis with tissue plasminogen activator in very old (> or =80 years) stroke patients. Stroke 36:2421–2425
Cho DY, Chen TC, Lee HC (2003) Ultra-early decompressive craniectomy for malignant middle cerebral artery infarction. Surg Neurol 60:227–232, discussion 232–223
Curry WT Jr, Sethi MK, Ogilvy CS, Carter BS (2005) Factors associated with outcome after hemicraniectomy for large middle cerebral artery territory infarction. Neurosurgery 56:681–692, discussion 681–692
Foerch C, Lang JM, Krause J, Raabe A, Sitzer M, Seifert V, Steinmetz H, Kessler KR (2004) Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction. J Neurosurg 101:248–254
Gupta R, Connolly ES, Mayer S, Elkind MS (2004) Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 35:539–543
Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363:768–774
Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996) ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53:309–315
Harscher S, Reichart R, Terborg C, Hagemann G, Kalff R, Witte OW (2006) Outcome after decompressive craniectomy in patients with severe ischemic stroke. Acta Neurochir (Wien) 148:31–37, discussion 37
Juttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, Woitzik J, Witte S, Jenetzky E, Hacke W (2007) Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 38:2518–2525
Kasner SE, Demchuk AM, Berrouschot J, Schmutzhard E, Harms L, Verro P, Chalela JA, Abbur R, McGrade H, Christou I, Krieger DW (2001) Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke 32:2117–2123
Kilincer C, Asil T, Utku U, Hamamcioglu MK, Turgut N, Hicdonmez T, Simsek O, Ekuklu G, Cobanoglu S (2005) Factors affecting the outcome of decompressive craniectomy for large hemispheric infarctions: a prospective cohort study. Acta Neurochir (Wien) 147:587–594, discussion 594
Marinkovic I, Strbian D, Pedrono E, Vekovischeva OY, Shekhar S, Durukan A, Korpi ER, Abo-Ramadan U, Tatlisumak T (2009) Decompressive craniectomy for intracerebral hemorrhage. Neurosurgery 65:780–786, 1 p following 786; discussion 786
Pillai A, Menon SK, Kumar S, Rajeev K, Kumar A, Panikar D (2007) Decompressive hemicraniectomy in malignant middle cerebral artery infarction: an analysis of long-term outcome and factors in patient selection. J Neurosurg 106:59–65
Qureshi AI, Ling GS, Khan J, Suri MF, Miskolczi L, Guterman LR, Hopkins LN (2001) Quantitative analysis of injured, necrotic, and apoptotic cells in a new experimental model of intracerebral hemorrhage. Crit Care Med 29:152–157
Qureshi AI, Mendelow AD, Hanley DF (2009) Intracerebral haemorrhage. Lancet 373:1632–1644
Qureshi AI, Suri MF, Ostrow PT, Kim SH, Ali Z, Shatla AA, Guterman LR, Hopkins LN (2003) Apoptosis as a form of cell death in intracerebral hemorrhage. Neurosurgery 52:1041–1047, discussion 1047–1048
Rabinstein AA, Mueller-Kronast N, Maramattom BV, Zazulia AR, Bamlet WR, Diringer MN, Wijdicks EF (2006) Factors predicting prognosis after decompressive hemicraniectomy for hemispheric infarction. Neurology 67:891–893
Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W (1998) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29:1888–1893
Staykov D, Huttner HB, Kohrmann M, Bardutzky J, Schellinger PD (2010) Novel approaches to the treatment of intracerebral haemorrhage. Int J Stroke 5:457–465
Uhl E, Kreth FW, Elias B, Goldammer A, Hempelmann RG, Liefner M, Nowak G, Oertel M, Schmieder K, Schneider GH (2004) Outcome and prognostic factors of hemicraniectomy for space occupying cerebral infarction. J Neurol Neurosurg Psychiatry 75:270–274
Vahedi K, Benoist L, Kurtz A, Mateo J, Blanquet A, Rossignol M, Amarenco P, Yelnik A, Vicaut E, Payen D, Bousser MG (2005) Quality of life after decompressive craniectomy for malignant middle cerebral artery infarction. J Neurol Neurosurg Psychiatry 76:1181–1182
Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, Hacke W (2007a) Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6:215–222
Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, Boutron C, Couvreur G, Rouanet F, Touze E, Guillon B, Carpentier A, Yelnik A, George B, Payen D, Bousser MG (2007b) Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 38:2506–2517
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Omary, R., Chernoguz, D., Lasri, V. et al. Decompressive Hemicraniectomy Reduces Mortality in an Animal Model of Intracerebral Hemorrhage. J Mol Neurosci 49, 157–161 (2013). https://doi.org/10.1007/s12031-012-9922-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12031-012-9922-2