Pilot Study: Zwitterionic Conditioning of the Decompressive Craniectomy Site for Early Cranioplasty Feasibility

Daniel C. Bartelt; Terry C. Yin; Steffen G. Osborn; Kameron R. Hansen; George C. Barrera; Kyle M. Ruby; Benjamin A. Brower; Faithe R. Cavalier; John P. Drey; Matthew A. Howard; C Allan Guymon; Marlan R. Hansen; Brian T. Andrews

doi:10.1177/27325016261483163

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Pilot Study: Zwitterionic Conditioning of the Decompressive Craniectomy Site for Early Cranioplasty Feasibility

Journal article

Peer reviewed

Pilot Study: Zwitterionic Conditioning of the Decompressive Craniectomy Site for Early Cranioplasty Feasibility

Daniel C. Bartelt, Terry C. Yin, Steffen G. Osborn, Kameron R. Hansen, George C. Barrera, Kyle M. Ruby, Benjamin A. Brower, Faithe R. Cavalier, John P. Drey, Matthew A. Howard, …

FACE (Thousand Oaks)

09/06/2026

DOI: 10.1177/27325016261483163

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Abstract

Background: Early cranioplasty after decompressive craniectomy (DC) for moderate-to-severe traumatic brain injury (TBI) improves functional recovery. However, patient candidacy is limited by persistent brain swelling, soft-tissue inflammation, and fibrotic wound remodeling. Zwitterion (ZI) hydrogels exhibit antifouling and anti-inflammatory properties that may improve the DC wound microenvironment. We hypothesize that ZI hydrogel application at the DC site attenuates TBI-associated biomarkers and improves motor recovery in rodents. Methods: Adult CD1 mice were randomized to sham, TBI, TBI/DC, or TBI/DC/ZI hydrogel (hereafter referred to as ZI hydrogel) groups to quantify serum GFAP, NfL, and UCH-L1 by ELISA at 24 hours. Adult Long Evans rats underwent the same interventions to assess ZI-dependent motor recovery using beam-walk time and limb slips normalized to baseline at days 7 and 14. Results: TBI significantly elevated serum GFAP and UCH-L1 versus sham (P = .0014 and .0471). Both TBI/DC and ZI hydrogel normalized GFAP, NfL, and UCH-L1 to sham-comparable levels; however, only ZI hydrogel significantly reduced NfL (P = .0256) and UCH-L1 (P = .0200) versus TBI/DC. Beam-walk testing showed no significant post-TBI motor deterioration in ZI hydrogel rats, whereas TBI/DC rats exhibited persistent deficits in crossing time and limb slips at days 7 and 14. Conclusions: ZI hydrogel application at the time of DC reduced TBI-specific serum biomarkers and improved motor recovery in a rodent moderate-to-severe TBI model. These findings support further investigation of ZI hydrogels as adjunctive therapy to attenuate neuroinflammation and facilitate earlier, safer cranioplasty after DC.

craniectomy

traumatic brain injury

zwitterion hydrogel

Details

Title: Subtitle: Pilot Study: Zwitterionic Conditioning of the Decompressive Craniectomy Site for Early Cranioplasty Feasibility
Creators: Daniel C. Bartelt - University of Iowa
Terry C. Yin - University of Iowa
Steffen G. Osborn - University of Iowa
Kameron R. Hansen - University of Iowa
George C. Barrera - University of Iowa
Kyle M. Ruby - University of Iowa
Benjamin A. Brower - University of Iowa
Faithe R. Cavalier - University of Iowa
John P. Drey - University of Iowa
Matthew A. Howard - University of Iowa
C Allan Guymon - Brigham Young University
Marlan R. Hansen - University of Iowa
Brian T. Andrews - University of Iowa
Resource Type: Journal article
Publication Details: FACE (Thousand Oaks)
DOI: 10.1177/27325016261483163
ISSN: 2732-5016
eISSN: 2732-5016
Publisher: Sage
Language: English
Electronic publication date: 09/06/2026
Academic Unit: Neurology; Molecular Physiology and Biophysics; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Craniofacial Anomalies Research Center; Chemical and Biochemical Engineering; Neurosurgery; Otolaryngology
Record Identifier: 9985224436702771

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