Skull resconstruction immediately following traumatic brain injury worsens brain damage
Immediate skull reconstruction following trauma that penetrates or creates an indentation in the skull can aggravate brain damage inflicted by the initial injury, a study by a University of South Florida research team reports. Using a rat model for moderate and severe traumatic brain injury, the researchers also showed that a delay of just two days in the surgical repair of skull defects resulted in significantly less brain swelling and damage.
The study was published March 16, 2012 in the online journal PloS ONE. While further investigation is needed, the findings have implications for the acute treatment of traumatic brain injury (TBI), considered the signature wound of soldiers who have served in Iraq and Afghanistan, said the study's principal investigator Cesar Borlongan, PhD, professor and vice chair of research at the USF Health Department of Neurosurgery and Brain Repair
"A double-edged sword," is how Borlongan describes the inflammation and subsequent swelling of brain tissue that occurs immediately following TBI.
When the brain is initially penetrated -- by a bullet, shrapnel, other debris, or even the force of blast waves, for instance -- inflammation helps recruit the body's own good (glial) cells to the damaged site to limit localized injury. For a short time, the inflammation-induced edema, or swelling of the brain, is beneficial to help relieve pressure within the skull. However, chronic inflammation precipitates increases in intracranial pressure that perpetuate a vicious cycle leading to secondary cell injury and death.
Cranioplasty is an operation to repair malformations of the skull caused by TBI; the procedure may involve replacing a missing piece of the skull protecting the underlying brain and/or improving the appearance of the skull's surface. Current clinical practice emphasizes performing cranioplasty quickly upon initial hospital admission to help reduce the likelihood of infection or other complications that may arise when the brain is exposed.
"Our preclinical study indicates that reconstructing the skull too early in the brain's natural healing process may interfere with critical therapeutic benefits of brain swelling post-TBI," Dr. Borlongan said. "It's better to wait at least two days."
The USF researchers studied rats with moderate and severe TBI. Post-TBI, the animals were randomly assigned to skull bone flap replacement with or without bone wax (a sterile mixture to help control bleeding from bone surfaces); no skull reconstruction; or delayed skull reconstruction with bone wax alone, which was performed two days following TBI.
The brains of all the animals were analyzed in the laboratory five days after surgery. While immediate reconstruction provided aesthetic repair of the skull fracture, this early surgical procedure, with bone wax alone or with bone wax and skull bone flap, significantly increased cortical brain tissue damage in both moderate and severe animal models.
Overall, whether the rat model was moderate or severe TBI, delayed reconstruction limited the worsening of brain tissue damage compared to immediate reconstruction. In fact, for moderate TBI, the extent of damage observed in the brains of rats that received delayed reconstruction was on a par with that in the animals getting no reconstruction. In those with severe traumatic brain injury, the tissue damage was significantly larger. The authors suggest this may mean a two-day delay, while more beneficial than immediate reconstruction, was not sufficient to counteract the intracranial pressure generated by severe TBI.
The researchers concluded that the timing of cranioplasty warrants further evaluation in both laboratory and clinical settings.
"Our results suggest that delaying cranioplasty until the TBI-induced cerebral swelling has subsided may reduce unwanted exacerbation of cortical damage associated with skull reconstruction," Borlongan said. "We need to carefully weigh the risk of infection that comes from leaving the brain somewhat exposed with the benefit of enhancing the brain's own repair of its cells."
"Finding a safe and effective cranioplasty regimen will require determining the optimal period of time when we let the brain repair itself and balancing that with when to best introduce a regimen of surgical skull repair and other potential therapies," said co-author Harry van Loveren, MD, the David W. Cahill endowed professor and chair of the USF Health Department of Neurosurgery and Brain Repair.
More information: "Immediate, but Not Delayed, Microsurgical Skull Reconstruction Exacerbates Damage in Experimental Traumatic Brain Injury Model;" Loren E. Glover, Naoki Tajiri, Tsz Lau, Yuji Kaneko, Harry van Loveren, Cesario V. Borlongan; PloS ONE 7(3), e33646, March 16, 2012.
Provided by University of South Florida
- Stem cells may provide treatment for brain injuries Mar 10, 2011 | not rated yet | 0
- Single traumatic brain injury may prompt long-term neurodegeneration Jul 18, 2011 | not rated yet | 0
- Growing evidence suggests progesterone should be considered a treatment option for traumatic brain injuries Dec 22, 2009 | not rated yet | 0
- How blast waves cause human brain injury even without direct head impacts? Aug 26, 2009 | not rated yet | 0
- Risk factors predictive of psychiatric symptoms after traumatic brain injury Jul 12, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(AP)—Tunisia's Health Ministry says a 66-year-old man has died after being infected by the new coronavirus following a visit to Saudi Arabia.
Diseases, Conditions, Syndromes 3 minutes ago | not rated yet | 0
(HealthDay)—For patients with acute respiratory distress syndrome (ARDS), prolonged prone positioning during mechanical ventilation is associated with significantly reduced mortality at 28 and 90 days, ...
Diseases, Conditions, Syndromes 24 minutes ago | not rated yet | 0
No new human cases of the H7N9 virus have been recorded in China for a week, national health authorities said, for the first time since the outbreak began in March.
Diseases, Conditions, Syndromes 2 hours ago | not rated yet | 0
A Nobel prize-winning scientist Tuesday played down "shock-horror scenarios" that a new virus strain will emerge with the potential to kill millions of people.
Diseases, Conditions, Syndromes 2 hours ago | 5 / 5 (1) | 0
Bacteria resistant to the antibiotic colistin are also commonly resistant to antimicrobial substances made by the human body, according to a study in mBio, the online open-access journal of the American Society for Microb ...
Diseases, Conditions, Syndromes 7 hours ago | 5 / 5 (1) | 0
(Medical Xpress)—Scientists at the School of Medicine have shown that their previously identified therapeutic approach to fight cancer via immune cells called macrophages also prompts the disease-fighting killer T cells ...
2 minutes ago | not rated yet | 0 |
(Medical Xpress)—Cardiologists have identified a trio of biomarkers that may predict which patients with heart disease have a high risk of heart attack or death in the next two years.
54 minutes ago | not rated yet | 0 |
(HealthDay)—When it comes to the care of your children's teeth, dentists aren't the only experts who can help.
4 minutes ago | not rated yet | 0
(Medical Xpress)—We spend about a third of our life asleep, but why we need to do so remains a mystery. In a recent publication, researchers at University of Surrey and University College London suggest a new hypothesis, ...
1 hour ago | not rated yet | 0
(Medical Xpress)—International researchers are studying the salt intake of Indian adults to provide vital new data to aid the development of a national salt reduction strategy.
54 minutes ago | not rated yet | 0
(Medical Xpress)—Exposure to sunshine as a small child is crucial to the development of a healthy eye according to results of long-term myopia study conducted by University of Sydney researchers.
44 minutes ago | not rated yet | 0