• Ivan Marinkovic, Daniel Strbian, Eric Pedrono, Olga Y Vekovischeva, Shashank Shekhar, Aysan Durukan, Esa R Korpi, Usama Abo-Ramadan, and Turgut Tatlisumak.
• Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
• Neurosurgery. 2009 Oct 1;65(4):780-6, 1 p following 786; discussion 786.

ObjectiveIntracerebral hemorrhage (ICH) has a high mortality rate and leaves most survivors disabled. The dismal outcome is mostly due to the mass effect of hematoma plus edema. Major clinical trials show no benefit from surgical or medical treatment. Decompressive craniectomy has, however, proven beneficial for large ischemic brain infarction with massive swelling. We hypothesized that craniectomy can improve ICH outcome as well.MethodsWe used the model of autologous blood injection into the basal ganglia in rats. After induction of ICH and then magnetic resonance imaging, animals were randomly allocated to groups representing no craniectomy (n = 10) or to craniectomy at 1, 6, or 24 hours. A fifth group without ICH underwent craniectomy only. Neurological and behavioral outcomes were assessed on days 1, 3, and 7 after ICH induction. Furthermore, terminal deoxynucleotidyl transferase dUTP nick-end labeling-positive cells were counted.ResultsAfter 7 days, compared with the ICH + no craniectomy group, all craniectomy groups had strikingly lower mortality (P < 0.01), much better neurological outcome (P < 0.001), and more favorable behavioral outcome. A trend occurred in the ICH + no craniectomy group toward more robust apoptosis.ConclusionDecompressive craniectomy performed up to 24 hours improved outcome after experimental ICH, with earlier intervention of greater benefit.

39 keywords...

hide…