Neuroprotective effects of hemicraniectomy in malign middle cerebral artery infarctions: Experimental study

Introduction: Despite optimal medical therapy the mortality rate approaches 50% in MCA infarctions. Although recent studies have been showed life-saving effect of hemicraniectomy; there are a few data available in regard to neuroprotection effect of decompressive craniectomy (DC). We induced a malign cerebral ischemia model by intraluminal permanent MCA occlusion (MCAo) in male rats for defining the neuroprotective effects of early DC on brain-blood barrier (BBB) moleculer changes, infarct size, cerebral edema. Material-Method: 70 male Spraque Dawley rats were allocated to 4 group; sham (n = 12), control (n = 16), experiment 1 (n = 20), experiment 2 (n = 22).DC was performed by creating a bone flap, after MCAo at 4th and 24th hours. After 28 hours of survival, all animals were sacrified. Infarction volumes were calculated from TTC(2,3,5,triphenyltetrozolium chloride)- stained brain sections. In all groups, cerebral edema were quantified as a change in % brain water content. Western Blot was used to analyze the expression of tight junction protein claudin-5 and occludin. EB (Evans Blue) and NaF (Sodium Flourescence ) staining was used to analyze the extravasation of BBB. Results: Brain water content was calculated 75.19±1,69% in the early DC group and 77,76 ± 1,60% in the late DC group. No significant difference was found between experiment groups. (p = .178) In the early DC group; occludin and claudin-5 were significantly expressed at higher levels compared to late DC group (for occludin p = .013 ; for claudin-5 p =.034). At early DC group (69.38 ± 57,11 mm3) the final infarct volumes were significantly smaller than in the late DC group (577,18 ± 468,37 mm3) (p = .014). For BBB staining (EB and NaF) ,there were no significant relationship.(respectively p=.274 ; p=.284 ) Conclusion: The study results supported the neuroprotective effects of early DC in malign MCA infarcts.