Effects of Decompressive Craniectomy with Mesh in the Level of Transforming Growth Factor Beta, Fibroblast Cell Count, Size of Fibrosis, and Clinical Adhesion of Peridural Tissues in Wistar Rat with Traumatic Brain Injury
I Wayan Niryana1,2
, Sri Maliawan1,2, I Made Bakta2 and I Nyoman Mantik Astawa21Department of Neurosurgery, Faculty of Medicine, Udayana University-Sanglah General Hospital, Bali, Indonesia
2Doctoral Program, Faculty of Medicine, Udayana University, Bali, Indonesia
Corresponding Author E-mail: niryana_wayan@hotmail.com
Abstract: One option to control intracranial pressure (ICP) is by performing decompressive craniectomy (DC) before definitive treatment. A common problem after DC is adhesion. Separated injured tissue surfaces by using bioabsorbable membranes over a critical/certain period are predicted to prevent fibrin bridge formation and adhesion. This study is conducted to prove the effects of DC with mesh on TGF-β levels, fibroblast cell count, fibrosis size and clinical adhesions in wistar rat with traumatic brain injury. The current research uses animal model with randomized post-test only control group design. A total of 20 samples that met the eligibility criteria were included in the study and randomized. A total of 10 samples were grouped as a control group (standard DC) and 10 samples were grouped as a study group (DC with mesh). On day 7, we performed euthanasia and took peridural tissue for examination of TGF-β levels, fibroblast cell count, and fibrosis size. The mean results of TGF-β in the study group were lower than the control group (81.28±17.48 pg/dl vs 93.83±9.51 pg/dl) although this difference was not statistically significant (p=0.062). For the mean number of fibroblasts cells, there was a significant difference where the study group was lower than the control group (56.8±20.59 cells/HPF vs 94.8±18.56 cells/HPF) with p<0.001. The mean size of peridural fibrosis also showed a significant difference where the mean size of peridural fibrosis in the study group was lower than the control group (1182.52±347.05 μm vs 1545.78±378.28 μm) with p=0.038. Only DC samples (without the use of mesh) had a relative risk 8 times greater for clinical adhesions compared to mesh (RR=8; 95% CI, 1,215-52,693; p=0,005). DC with mesh significantly resulted in low fibroblast cells count, size of peridural fibrosis, and the risk of clinical adhesions in wistar rat with traumatic brain injury.
Keywords: Traumatic brain injury; mesh, TGF-β; fibroblast cell counts; fibrosis size; clinical adhesions; peridural tissue Back to TOC