Biochemical markers of cerebrospinal ischemia after repair of aneurysms of the descending and thoracoabdominal aorta.
OBJECTIVE
To investigate the clinical potential of several markers of spinal cord ischemia in cerebrospinal fluid (CSF) and serum during aneurysm repair of the descending thoracic or thoracoabdominal aorta.


METHODS
Observational study of consecutive patients. Nonblinded, nonrandomized.


METHODS
University hospital thoracic surgical unit.


METHODS
Eleven consecutive elective patients.


METHODS
Distal extracorporeal circulation and maintenance of CSF pressure <10 mmHg until intrathecal catheter removal.


RESULTS
CSF and serum levels of S100B (and its isoforms S100A1B and S100BB), neuronal-specific enolase (NSE), and the CSF levels of glial fibrillary acidic protein (GFAp) and lactate were determined. Two patients had postoperative neurologic deficit. One with a stroke showed a 540-fold increased GFAp, a 6-fold NSE, and S100B increase in CSF. One with paraplegia had a 270-fold increase in GFAp, a 2-fold increase in NSE, and 5-fold increased S100B in CSF. One patient without deficit increased GFAp 10-fold, NSE 4-fold, and S100B 23-fold in CSF. CSF lactate increased >50% in 6 of 9 patients without neurologic deficit. Serum S100B increased within 1 hour of surgery in all patients without any concomitant increase in CSF. S100A1B was about 70% of total S100B in both serum and CSF in patients with or without neurologic defects. S100B in CSF increased 3-fold in 3 of 9 asymptomatic patients.


CONCLUSIONS
In patients with neurologic deficit, GFAp in CSF showed the most pronounced increase. Biochemical markers in CSF may increase without neurologic symptoms. There is a significant increase in serum S100B from surgical trauma alone without any increase in CSF.
Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Stockholm, Sweden. russell.anderson@kirurgi.ki.se
Russell E
RE
Anderson
Anders
A
Winnerkvist
Lars-Olof
LO
Hansson
Olle
O
Nilsson
Lars
L
Rosengren
Göran
G
Settergren
Jarle
J
Vaage
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000134:cerebrospinal fluid* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000097:blood / Q000134:cerebrospinal fluid* / Q000601:surgery*; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid*; D002555:Cerebrospinal Fluid / Q000737:chemistry* / Q000378:metabolism; D017558:Elective Surgical Procedures; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood / Q000134:cerebrospinal fluid; D006801:Humans; D019344:Lactic Acid / Q000097:blood / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood / Q000134:cerebrospinal fluid; D010264:Paraplegia / Q000097:blood / Q000134:cerebrospinal fluid / Q000209:etiology; D010751:Phosphopyruvate Hydratase / Q000097:blood / Q000134:cerebrospinal fluid; D011183:Postoperative Complications / Q000097:blood / Q000134:cerebrospinal fluid* / Q000209:etiology*; D012086:Reoperation; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood / Q000134:cerebrospinal fluid; D012720:Severity of Illness Index; D020760:Spinal Cord Ischemia / Q000097:blood / Q000134:cerebrospinal fluid* / Q000209:etiology*; D013223:Statistics as Topic; D020521:Stroke / Q000097:blood / Q000134:cerebrospinal fluid / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human; D019344:Lactic Acid; D010751:Phosphopyruvate Hydratase