DECOMPRESSIVE CRANIECTOMY IN A RAT MODEL OF MALIGNANT CEREBRAL HEMISPHERIC STROKE - EXPERIMENTAL SUPPORT FOR AN AGGRESSIVE THERAPEUTIC APPROACH

Acute ischemia in the complete territory of the carotid artery may lea d to massive cerebral edema with raised intracranial pressure and prog ression to coma and death due to uncal, cingulate, or tonsillar hernia tion. Although clinical data suggest that patients benefit from underg oing decompressive surgery for acute ischemia, little data about the e ffect of this proscedure on experimental ischemia are available. In th is article the authors present results of an experimental study on the effects of decompressive craniectomy pet-formed at various time point s after endovascular middle cerebral artery (MCA) occlusion in rats. F ocal cerebral ischemia was induced in 68 rats using an endovascular oc clusion technique focused on the MCA. Decompressive cranioectomy was p erformed in 48 animals (in groups of 12 rats each) 4, 12, 24, or 36 ho urs after vessel occlusion. Twenty animals (control group) were not tr eated by decompressive craniectomy. The authors used the infarct volum e and neurological performance at Day 7 as study endpoints. Although t he 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 decompres sive craniectomy, regardless of whether they were treated early or lat e. 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 late r time points did not significantly reduce infarction size. The result s suggest that use of decompressive craniectomy in treating cerebral i schemia reduces mortality and significantly improves outcome. If perfo rmed early after vessel occlusion, it also significantly reduces infar ction size. By performing decompressive craniectomy neurosurgeons will play a major role in the management of stroke patients.