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  • Effect of Internal Jugular Vein Compression on Intracranial Hemorrhage in a Porcine Controlled Cortical Impact Model

    Final Number:
    1355

    Authors:
    Brian Sindelar MD; Julian E. Bailes MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Internal jugular vein (IJV) compression has been shown to reduce pathological markers of traumatic brain injury (TBI). However, this novel preventative approach to managing TBI raises concerns of worsening hemorrhage due to the resultant venous congestion. This study aims to test the hypothesis that IJV compression increases hemorrhage after controlled cortical impact (CCI) injury in the swine model.

    Methods: 12 swine were randomized to placement of a bilateral IJV compression collar or no collar (control) prior to a right frontal CCI injury. A histological grading of the extent of subarachnoid hemorrhage (SAH) was done in a blinded manner to measure the magnitude of hemorrhage in the collar and control animals. Other various measures of TBI histology were also analyzed including: ?-amyloid precursor protein (?-APP) expression, presence of degenerating neurons, extent of cerebral edema, inflammatory infiltrates, and amount of intra-parenchymal hemorrhage.

    Results: Following euthanasia five hours after injury, the collared (c) animals exhibited a significant reduction in total subarachnoid hemorrhage score from the control (uc) animals (uc: 7.13 2.2 versus c: 3.58 2.2, p=0.029) and intra-parenchymal hemorrhage score (uc: 3.0 1.3 versus c: 0.7 11.2, p=0.017). There was no statistically significant difference in scoring for the other markers of TBI (APP, neuronal degeneration, cerebral edema, or inflammatory infiltration).

    Conclusions: IJV compression prior to injury was shown to reduce hemorrhage (subarachnoid and intra-parenchymal hemorrhage) in the porcine CCI model when applied prior to injury. The previous work, displaying reduced histological markers of TBI, in concert with this promising animal safety trial proposes the feasibility of IJV compression for TBI mitigation in the clinical environment.

    Patient Care: Pre-clinical study providing evidence that IJV compression may be a possible prophylactic measure to traumatic brain injury

    Learning Objectives: Understand potential of intracranial prophylactic measures to traumatic brain injury care

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