Comparison of the Effects of Surgical Decompression and Resection of Local Edema in the Therapy of Experimental Brain Trauma

Abstract

The effect of decompressive trepanation was compared to that of surgical resection of the traumatized tissue in the course of traumatic brain edema in standardized experimental brain trauma. Following a right parietal cold injury, the following parameters were monitored continuously in 12 cats: ventricular pressure, epidural pressure over both hemispheres, arterial and central venous pressure and heart rate. The EEG was evaluated continuously, using a computer (power spectra). After catheterization of the superior sagittal sinus, cerebral arteriovenous differences of glucose, lactate, O₂ and CO₂ were calculated. 6 animals were treated surgically when showing elevated intracranial pressure ICP and markedly altered EEG. In 3 animals, the right hemisphere was decompressed by extensive resection of bone and dura. In 3 further animals, the softened brain tissue of the cold lesion was resected and the skull defect closed. 6 untreated animals were used as controls.A decompression by skull hemiresection for ablation of the injured cortex abolished the high intracranial pressure, but only the latter method seemed to prevent further damage. This could be demonstrated by the EEG registration, and by the normalization of arteriovenous metabolite differences. Only animals treated with edema resection had a normal arousal reaction and survived the trauma. The results indicate, that only an ablation of the local injury will prevent further damage to the brain. After decompressive trepanation alone, the progression of tissue edema is not interrupted. As can be seen from the literature, the poor results obtained even from extensive decompressive operations in traumatic brain edema, indicate that the further development of edema is independent of the intracranial pressure, whereas the Comparison of the Effects of Surgical Decompression and Resection of Edema 485 favorable results of resection of lobar contusions show an interruption of the spread of dysbolism.

Complications of decompressive craniectomy for traumatic brain injury

“…59 Brain edema following decompressive craniectomy has been modeled in animal studies of injury using Evans blue dye extravasation. 15,25,69 Cooper et al 15 found a 7-fold increase in edema formation as determined by Evans blue dye extravasation following craniectomy. Evidence of increased brain edema following craniectomy has not been verified in humans.…”

Effect of Decompression Craniotomy on Increase of Contusion Volume and Functional Outcome after Controlled Cortical Impact in Mice

“…The indication, the timing, and sometimes the technique of craniotomy are widely debated and therefore DC remains a "second tier" therapeutic option for patients with TBI (Guerra et al, 1999;Munch et al, 2000). Surprisingly not only clinical but also experimental data on the therapeutic role of DC after brain trauma are unclear (Burkert et al, 1989;Cooper et al, 1979;Gaab et al, 1979;Moody et al, 1968;Rinaldi et al, 1990). Although most authors agree that craniotomy lowers pathological ICP (Gaab et al, 1979;Moody et al, 1968;Rinaldi et al, 1990), an increase in brain edema formation and histopathological damage of the brain was also observed after craniotomy (Cooper et al, 1979;Moody et al, 1968;Rinaldi et al, 1990).…”

“…Surprisingly not only clinical but also experimental data on the therapeutic role of DC after brain trauma are unclear (Burkert et al, 1989;Cooper et al, 1979;Gaab et al, 1979;Moody et al, 1968;Rinaldi et al, 1990). Although most authors agree that craniotomy lowers pathological ICP (Gaab et al, 1979;Moody et al, 1968;Rinaldi et al, 1990), an increase in brain edema formation and histopathological damage of the brain was also observed after craniotomy (Cooper et al, 1979;Moody et al, 1968;Rinaldi et al, 1990). In view of such controversial findings and the fact that these studies were performed in non-mechanical, experimental TBI models, we decided to investigate the effect of DC on histopathological and functional outcome after controlled cortical impact (CCI) brain injury.…”

Development of a Neurosurgical Operating Table for Adult Cattle and Changes in Intracranial Pressure and Blood Pressure in Adult Cattle undergoing Long-Time Isoflurane Anesthesia

“…The monitor and control of ICP with neurosurgery is carried out in human, dog and cat [1,5,19], and it is important for the management of brain edema and hemorrhage [19,24]. However, in cattle, very little research has been conducted on changes in ICP [2].…”