(Stroke. 1999;30:1456-1463.)
© 1999 American Heart Association, Inc.
Original Contributions |
Decompressive Craniectomy, Reperfusion, or a Combination for Early Treatment of Acute "Malignant" Cerebral Hemispheric Stroke in Rats?
Potential Mechanisms Studied by MRI
From the Department of Radiology, Stanford University (Calif) (T.E., A.K., C.B., A. de C., M.E.M.), and the Department of Neuroradiology, University of Essen (Germany) (A.D., M.F.).
Correspondence to Arnd Doerfler, MD, Essen University School of Medicine, Department of Neuroradiology, Hufelandstrasse 55, D-45122 Essen, Germany. E-mail arnd.doerfler{at}uni-essen.de
Background and Purpose—Both early reperfusion and decompressive craniectomy have proved beneficial in the treatment of large space-occupying "malignant" hemispheric stroke. The aim of this study was to directly compare the benefit of reperfusion with that of craniectomy and to study the effects of combined treatment in a rat model of focal cerebral ischemia.
Methods—Cerebral ischemia was introduced in 28 rats. Four groups were investigated: (1) no treatment, (2) decompressive craniectomy, (3) reperfusion, and (4) reperfusion and craniectomy as treatment at 1 hour after middle cerebral artery occlusion. Perfusion- and diffusion-weighted MRI were performed serially from 0.5 to 6 hours after middle cerebral artery occlusion.
Results—The 6-hour DWI-derived hemispheric lesion volumes in the reperfusion group (10.2±3.9%), the craniectomy group (23.0±6.4%), and the combination group (21.8±12.4) were significantly smaller than that in the control group (44.1±5.4%) (P<0.05). Reperfusion, craniectomy, and combined treatment led to higher perfusion in the cortex compared with the control group, whereas only reperfused animals achieved significantly higher perfusion in the basal ganglia. In 5 animals, combined reperfusion and decompressive craniectomy resulted in an early contrast media enhancement.
Conclusions—Early reperfusion and craniectomy were shown to be effective in decreasing infarction volume by improving cerebral perfusion. Reperfusion remains the best therapy in malignant hemispheric stroke. Combined treatment yields no additional benefit compared with single treatment, probably because of early blood-brain barrier breakdown.
Editorial Comment
Potential Mechanisms Studied by MRI
Department of Internal Medicine, Cardiovascular Center, University of Iowa College of Medicine, Iowa City, Iowa
This article has been cited by other articles:
 |
|
 |
|
  T. Engelhorn, A. Doerfler, M. Forsting, G. Heusch, and R. Schulz Does a Relative Perfusion Measure Predict Cerebral Infarct Size? AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2218 - 2223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Engelhorn, A. Doerfler, J. Weise, M. Baehr, M. Forsting, and A. Hufnagel Cerebral Perfusion Alterations during the Acute Phase of Experimental Generalized Status Epilepticus: Prediction of Survival By Using Perfusion-Weighted MR Imaging and Histopathology AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1563 - 1570. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hofmeijer, J. Schepers, W.B. Veldhuis, K. Nicolay, L.J. Kappelle, P.R. Bar, and H.B. van der Worp Delayed Decompressive Surgery Increases Apparent Diffusion Coefficient and Improves Peri-Infarct Perfusion in Rats With Space-Occupying Cerebral Infarction Stroke, June 1, 2004; 35(6): 1476 - 1481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Gerriets, E. Stolz, M. Walberer, C. Muller, A. Kluge, A. Bachmann, M. Fisher, M. Kaps, and G. Bachmann Noninvasive Quantification of Brain Edema and the Space-Occupying Effect in Rat Stroke Models Using Magnetic Resonance Imaging Stroke, February 1, 2004; 35(2): 566 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M B Pranesh, S Dinesh Nayak, V Mathew, B Prakash, M Natarajan, V Rajmohan, R Murali, and A Pehlaj Hemicraniectomy for large middle cerebral artery territory infarction: outcome in 19 patients J. Neurol. Neurosurg. Psychiatry, June 1, 2003; 74(6): 800 - 802. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Engelhorn, R. von Kummer, W. Reith, M. Forsting, and A. Doerfler What Is Effective in Malignant Middle Cerebral Artery Infarction: Reperfusion, Craniectomy, or Both?: An Experimental Study in Rats Stroke, February 1, 2002; 33(2): 617 - 622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Doerfler, S. Schwab, T. T. Hoffmann, T. Engelhorn, and M. Forsting Combination of Decompressive Craniectomy and Mild Hypothermia Ameliorates Infarction Volume After Permanent Focal Ischemia in Rats Stroke, November 1, 2001; 32(11): 2675 - 2681. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Kasner, A. M. Demchuk, J. Berrouschot, E. Schmutzhard, L. Harms, P. Verro, J. A. Chalela, R. Abbur, H. McGrade, I. Christou, et al. Predictors of Fatal Brain Edema in Massive Hemispheric Ischemic Stroke Stroke, September 1, 2001; 32(9): 2117 - 2123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Doerfler, T. Engelhorn, M. Forsting, C. Oppenheim, and Y. Samson Decompressive Craniectomy for Early Therapy and Secondary Prevention of Cerebral Infarction Response Stroke, March 1, 2001; 32(3): 813 - 815. [Full Text] [PDF]
|
|
|
|
|
|
M Holtkamp, K Buchheim, A Unterberg, O Hoffmann, E Schielke, J R Weber, and F Masuhr Hemicraniectomy in elderly patients with space occupying media infarction: improved survival but poor functional outcome J. Neurol. Neurosurg. Psychiatry, February 1, 2001; 70(2): 226 - 228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Gerriets, E. Stolz, S. Konig, S. Babacan, I. Fiss, M. Jauss, and M. Kaps Sonographic Monitoring of Midline Shift in Space-Occupying Stroke : An Early Outcome Predictor Stroke, February 1, 2001; 32(2): 442 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Neumann-Haefelin, A. Kastrup, A. de Crespigny, M. A. Yenari, T. Ringer, G. H. Sun, M. E. Moseley, and M. Fisher Serial MRI After Transient Focal Cerebral Ischemia in Rats : Dynamics of Tissue Injury, Blood-Brain Barrier Damage, and Edema Formation Editorial Comment: Dynamics of Tissue Injury, Blood-Brain Barrier Damage, and Edema Formation Stroke, August 1, 2000; 31(8): 1965 - 1973. [Abstract] [Full Text] [PDF]
|
|