Secondary massive cerebral infarction (MCI), the predominant prognostic factor of cerebral herniation from epidural hematoma (EDH), determines a need for decompressive craniectomy. However, few predictive indices have focused on it. In this study, we tested the clinical feasibility and reliability of a novel pre-operative risk scoring system (EDH-MCI scale) in the guidance of surgical decision-making. The scale is comprised of 6 risk factors, including location and volume of hematoma, duration and extent of preoperative cerebral herniation, Glasgow Coma Scale score, and presence of preoperative shock, with a total score ranging from 0 to 18 points. Results suggest that the accuracy of the surgical modality adapted for initial hematoma-evacuation surgery of 65 patients whose surgical modality were guided by the EDH-MCI scale (prospective cohort, 2012.02-2014.01) were significantly improved (95.38% vs. 77.95%, P=0.002) compared with those of an independent set of 126 patients (retrospective cohort, 2007.01-2012.01) whose surgical modalities were decided empirically. The EDH-MCI scale exhibited a satisfactory predictive capacity for the development of secondary MCI and discriminative performance for patients who were at high risk and thus required radical surgical treatments. It is suggested that simple hematoma-evacuation craniotomy was sufficient for patients with low risk scores (<=9 points), whereas decompressive craniectomy in combination with duraplasty were necessary for those with high risk scores (>=13 points). In patients with borderline risk scores (10-12 points), those having one or more of unstable vital signs, coexistence of severe secondary brainstem injury, and irresponsiveness of dilated pupils to emergent burr-hole hematoma-drainage had a significantly increased incidence of posttraumatic MCI, which underlined a high priority for radical surgical treatments. In conclusion, this novel pre-operative risk evaluation scale is easy to use and has a satisfactory predictive capacity forthe development of secondary MCI, thereby providing an objective reference for surgical-decision making and postoperative medical care.
Previous studies have shown that vagus nerve stimulation can improve the prognosis of traumatic brain injury. The aim of this study was to elucidate the mechanism of the neuroprotective effects of vagus nerve stimulation in rabbits with brain explosive injury. Rabbits with brain explosive injury received continuous stimulation (10 V, 5 Hz, 5 ms, 20 minutes) of the right cervical vagus nerve. Tumor necrosis factor-?, interleukin-1? and interleukin-10 concentrations were detected in serum and brain tissues, and water content in brain tissues was measured. Results showed that vagus nerve stimulation could reduce the degree of brain edema, decrease tumor necrosis factor-? and interleukin-1? concentrations, and increase interleukin-10 concentration after brain explosive injury in rabbits. These data suggest that vagus nerve stimulation may exert neuroprotective effects against explosive injury via regulating the expression of tumor necrosis factor-?, interleukin-1? and interleukin-10 in the serum and brain tissue.
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