Abstract
ABSTRACTPurposeTo evaluate the effects of controlled decompression and rapid decompression, explore the potential mechanism, provide the theoretical basis for the clinical application, and explore the new cell death method in intracranial hypertension.MethodsAcute intracranial hypertension was triggered in rabbits by epidural balloon compression. New Zealand white rabbits were randomly put into the sham group, the controlled decompression group, and the rapid decompression group. Brain water content, etc., was used to evaluate early brain injury. Western blotting and double immunofluorescence staining were used to detect necroptosis and apoptosis.ResultsBrain edema, neurological dysfunction, and brain injury appeared after traumatic brain injury (TBI). Compared with rapid decompression, brain water content was significantly decreased, neurological scores were improved by controlled decompression treatment. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining and Nissl staining showed neuron death decreased in the controlled decompression group. Compared with rapid decompression, it was also found that apoptosis-related protein caspase-3/ tumor necrosis factor (TNF)-a was reduced markedly in the brain cortex and serum, and the expression levels of necroptosis-related protein, receptor-interacting protein 1 (RIP1)/receptor-interacting protein 1 (RIP3) reduced significantly in the controlled decompression group.ConclusionsControlled decompression can effectively reduce neuronal damage and cerebral edema after craniocerebral injury and, thus, protect the brain tissue by alleviating necroptosis and apoptosis.
Highlights
IntroductionSevere traumatic brain injury (sTBI) is a common condition in neurosurgery
Severe traumatic brain injury is a common condition in neurosurgery
It was found that apoptosis-related protein caspase-3/ tumor necrosis factor (TNF)-a was reduced markedly in the brain cortex and serum, and the expression levels of necroptosis-related protein, receptor-interacting protein 1 (RIP1)/receptor-interacting protein 1 (RIP3) reduced significantly in the controlled decompression group
Summary
Severe traumatic brain injury (sTBI) is a common condition in neurosurgery. The increased intracranial pressure (ICP) is one of the main causes of death after sTBI3,4. The standard decompressive craniotomy is currently the conventional surgery for sTBI in neurosurgery, since it rapidly decreases ICP to minimize brain damage[5]. A previous study has associated traditional standard decompressive craniotomy with the occurrence of several complications, such as intraoperative acute encephalocele and postoperative cerebral ischemia[6]. A study reported that conventional standard decompressive craniotomy can lead to hyperemia and over perfusion after cerebral ischemia[7]. More research is required on how to improve the surgery to reduce the incidence of complications
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