Skull reconstruction immediately following a traumatic brain injury (TBI) in which the skull is penetrated or indented can aggravate brain damage caused by the initial injury, according to a study conducted by researchers at the University of South Florida. The study was published this month in the online Journal of PloS ONE.
Cesar Borlongan, the study’s principal investigator, describes the inflammation and subsequent swelling of the brain tissue that occurs immediately following TBI as a “double edged sword.” When the skull is initially penetrated, whether it be by a sharp object or even by blunt force, inflammation helps drive the body’s good cells to the damaged site to limit localized injury.
For a short time, the swelling caused by the injury is beneficial to help relieve pressure within the skull. However, chronic inflammation increases pressure in the head that, Borlongan says, perpetuates a vicious cycle that can lead to secondary cell injury and death.
Surgery to repair malformations of the skull caused by TBI may include replacing a missing piece of skull in order to protect the underlying brain or improve the appearance of the skull’s surface. Current medical practice supports performing this surgery quickly to help reduce the likelihood of infection or other complications that may arise when the brain is exposed. However, researchers say that doing this procedure too early may interfere with the therapeutic benefits of brain swelling.
Researchers used rat models with moderate and severe TBI to assess their theory. They found that 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 TBI, the tissue damage was significantly larger.
Researchers say this may mean a two-day delay, while more beneficial than immediate reconstruction, was not sufficient to counteract the pressure in the head caused by by severe TBI. The researchers concluded that the timing of surgery warrants further evaluation in both the laboratory and clinical settings.
Source: News Medical