Prognostic significance of SSEP, BAEP and serum S-100B monitoring after aneurysm surgery.
OBJECTIVE
Changes in evoked potentials (EPs) and increased levels of S-100B protein were used to identify cerebral ischemia or glial damage and to predict neurological outcome in aneurysm patients.


METHODS
Somatosensory evoked potentials and Brainstem auditory-evoked potentials, and serum S-100B protein were simultaneously investigated pre- and postoperatively over a period of 10 days in 43 patients with 47 aneurysms (six in the posterior fossa).


RESULTS
The EP scores showed a strong correlation with the clinical outcome. Sensitivity was 73%, and specificity 81%. Pathological S-100B levels >0.5 mg/l were equal in predictive values (correct positive eight, false positive six, correct negative 26, false negative three). Initially increased S-100B levels, long-lasting S-100B elevation, and secondary increasing S-100B values correlated with an unfavorable outcome. High peak S-100B values correlated with bad EP scores at discharge. EP deterioration was the first indicator anticipating S-100B elevation and clinical deterioration in five patients. There was a good correlation between pathological S-100B values or EP findings and infarction on CT scan.


CONCLUSIONS
Both EPs and S-100B protein showed a comparable high predictive value for outcome. S-100B reflects the extent of primary brain damage after subarachnoid hemorrhage and time course of ongoing secondary brain damage. Evoked potentials assess the functional integrity and tended to react earlier than S-100B protein before definitive structural damage occurred.
Schick
U
U
Department of Neurosurgery, University of Leipzig, Leipzig, Germany. Uta_Schick@web.de
Döhnert
J
J
Meyer
J-J
JJ
Vitzthum
H-E
HE
D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D001303:Auditory Cortex / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000175:diagnosis*; D004594:Electrophysiology; D005072:Evoked Potentials, Auditory; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors; D011182:Postoperative Care; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D013003:Somatosensory Cortex / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins