Publikationsserver der RWTH Aachen University
MR-tomographische Untersuchungen zur Entwicklung eines verspäteten Hirnödems nach operativer Ausräumung intrazerebraler Blutungen im Schweinemodell
Abstract
dc:descriptionObjectives: Spontaneous intracerebral hemorrhage is associated with high mortality and morbidity. Despite of countless clinical and experimental trials, no evidence-based therapy can be recommended. The therapeutic alternatives include best medical therapy, surgical therapy via craniotomy and lysis of the intracerebral clot with rt-PA and stereotactic aspiration. In recent controlled clinical trials, surgical therapy was not clearly followed by lower mortality or morbidity. Additionally, application of rt-PA into neuronal tissue is associated with enlargement of the perifocal edema and the inflammatory response. Based on former animal studies, an intracerebral hematoma was inducted in pigs and removed via craniotomy. These animals were compared with animals after untreated ICB and after lysis with rt-PA and stereotactic removal of the clot. To demonstrate the traumatic effect of balloon dilatation in the brain, one group of animals were only treated like that. The objective of this study was the evaluation of the perifocal edema over 10 days and to determine if classic craniotomy is prior to local fibrinolysis regarding local edema formation despite of its higher invasiveness.Methods: 18 pigs were operated, 11 of those underwent balloon dilatation in the right frontal white matter alone, 7 underwent open craniotomy after injection of autologous blood into the cavity. MRI scans were performed directly after hematoma induction and at the 2nd, 4th and 10th day. For edema quantification, T2-weighted fluid attenuated inversion recovery (FLAIR) images were acquired. The results were compared to animals of a former study which were treated with either conservative therapy or lysis and aspiration of the clot.Results: Out of the 18 animals in the trial, 14 could be used in the statistical analysis. The animals after balloon dilatation alone suffered from a statistically significant increase in edema value between day 0 and day 2 and a decrease between day 4 and day 10. Altogether, they developed a statistically significant increase in perifocal edema between day 0 and day 10. The animals which underwent open craniotomy developed no significant changes in edema volume during the observation time. Regarding the animals of former studies, a statistical significant increase in edema volume occurred after conservative treatment of an ICB between day 0 and day2 and after lysis with rt-PA between day 0 and day 2 and between day 0 and day 10. Animals which underwent balloon dilatation developed a significantly smaller edema than animals after conservatively treated ICB on day 0, 2 and 10. Animals after open craniotomy developed a smaller edema than animals after conservatively treated ICB during the whole observation period, the difference in volume was statistically significant on day 2 and 4. Regarding the operated animals, edema formation was smaller after open craniotomy than after lysis with rt-PA in all postoperative examinations.Conclusion: Although a significant reduction of ICB volume can be achieved after lysis with rt-PA, the development of a perifocal edema is increased. In contrast to that, animals which underwent open craniotomy developed no statistically significant changes in edema volume during the observation period despite of the more invasive operation technique. These results also emphasize the benefit of reduction of ICB volume and the toxic blood products derived from the clot regarding the formation of a perifocal edema.
Degree
thesis:*- Grantor dc:publisher
- Publikationsserver der RWTH Aachen University
- Year dc:date
- 2008
Author and committee
dc:creator, dc:contributor.*- Author dc:creator
-
- Kayser, Carolin
- Contributors dc:contributor
-
- Gilsbach, Joachim M.
Subjects
dc:subject × 11Rights
dc:rights- Statement dc:rights
-
- info:eu-repo/semantics/openAccess
- Language dc:language
- ger