According to a brand new study, the controlled application of vacuum pressure may offer another effective means of mitigating tissue damage immediately following a traumatic brain injury (TBI). New findings were outlined in an experimental study published in the August issue of Neurosurgery, official journal of the Congress of Neurological Surgeons.
The new procedure is called mechanical tissue resuscitation (MTR). MTR is designed to stop brain tissue damage caused by swelling by applying vacuum pressure over the injured area of the brain. The treatment may offer a safe and effective treatment for TBI, according to the research efforts led by Dr. Louis C. Argenta and Dr. Michael Morykwas accompanied by several co investigators of Wake Forest University of Health Sciences, Winston-Salem, N.C. Despite its early success, the technique still requires further development before it can be studied in human subjects with traumatic brain injuries.
The North Carolina-based study was funded by a major grant from the U.S. Army. For the experiment, researchers tested the mechanical tissue resuscitation approach by inducing a localized brain injury in swine. Next, negative pressure (a mild vacuum) was applied using a small incision through the skull over the injured area of the brain. The effect was similar to the pull of a suction cup drawing up on the injured tissue area through a small hole. The research compared the effects of different levels of pressure on the injured area, 50 or 100 millimeters of mercury (mm Hg); and also different application periods, three or five days; and different delay times, up to six hours after injury.
The study’s results revealed measurable benefits of applying vacuum pressure after a TBI. Applying 100 mm Hg of pressure for three days led to a significantly smaller area of brain contusion and drastically reduced bleeding, compared to no pressure or 50 mm Hg of pressure. Afterward, brain MRI scans revealed a more-normal appearance of brain tissue in the vacuum-treated animals, which was further confirmed by eventual post-mortem examination of the affected areas of the brain.
All of the test animals survived after five days of vacuum application. In comparison, nearly 50 percent of the animals died when treatment was discontinued after three days. The response to vacuum pressure was generally no different when treatment was delayed for three hours, compared with no delay in vacuum treatment. From what the scientists can ascertain thus far, the procedure appears to be safe, lacking any advent of seizures or brain deformation.
Serious traumatic brain injury cases are complex and can be debilitating. Severe injury cases often result in disability or death and have very limited treatment options. After a TBI, impaired circulation and accumulation of metabolites and water in the area of injury lead to progressive secondary injury and neuronal (brain cell) degeneration.
The new negative pressure application was derived from its successful administration to promote healing in other types of wounds. In earlier studies, Drs. Argenta and Morykwas and colleagues found benefits of controlled vacuum application to localized areas of TBI in rats. In this latest study, however, they sought to evaluate the safety and effectiveness of this mechanical tissue resuscitation technique in a large-animal model with closer similarities to the human brain after TBI. The researchers determined:
“The ability of mechanical tissue resuscitation to achieve meaningful reduction in loss of brain tissue and hemorrhage injury warrants further investigation.”
Scientists are still unsure as to exactly how mechanical tissue resuscitation could work to reduce the area of tissue damage after TBI. One theory is the vacuum may act by increasing blood flow to the injured tissue, thus promoting oxygenation, nutrient supply, and rapid disposal of waste products. The study’s lead scientists are now performing further studies to optimize the mechanical tissue resuscitation technique before initial trials in human patients with TBI.
References:
Claims Journal – https://www.claimsjournal.com/news/national/2014/08/01/252716.htm
