Delayed Decompressive Surgery Increases Apparent Diffusion Coefficient and Improves Peri-Infarct Perfusion in Rats With Space-Occupying Cerebral Infarction

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Background and Purpose—

There is no conclusive experimental support that decompressive surgery in late stages of space-occupying cerebral infarction will improve outcome. We studied the effects of delayed decompressive surgery on the development of tissue damage, edema formation, and cerebral perfusion with different MRI techniques in a rat model of space-occupying cerebral infarction.


Permanent middle cerebral artery (MCA) occlusion was performed in 6 Fisher 344 rats. Decompressive surgery was performed 17 hours after the occlusion. Each animal was assessed before surgery and 2 and 4 hours after surgery by means, of diffusion-weighted T2-weighted, and flow-sensitive alternating inversion recovery perfusion-weighted MRI. Ischemic damage was also evaluated in hematoxylineosin-stained brain sections.


Lesion volume as derived from apparent diffusion coefficient (ADC) maps decreased from 522±98 mm3 before to 405±100 mm3 (P = 0.016) 4 hours after decompressive surgery, whereas lesion volume from T2 maps increased from 420±66 mm3 before to 510±92 mm3 (P = 0.048) 4 hours after decompressive surgery. Midline shift decreased from 1.4±0.1 mm to 0.5±0.2 mm (P = 0.001). Blood flow in the noninfarcted area of the ipsilateral hemisphere improved from 25±9 mL/min/100 g of tissue to 38±9 mL/min/100 g of tissue (P = 0.035). Despite the pseudonormalization of ADC, irreversible damage was found in the entire MCA territory on histological evaluation.


In rats with space-occupying cerebral infarction, delayed decompressive surgery leads to a decrease in lesion volume derived from ADC maps, which is probably because of an increase of extracellular water formation. There are no signs that this reflects rescue of ischemic tissue.

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