title: Early postoperative serum S100 beta levels predict ongoing brain damage after meningioma surgery: a prospective observational study.
abstract: BACKGROUND
  Elevated serum levels of S100beta, an astrocyte-derived protein, correlate with unfavourable neurological outcomes following cardiac surgery, neurotrauma, and resuscitation. This study evaluated whether pre-/postoperative serum S100beta levels correlate with unfavourable clinical and radiological findings in patients undergoing elective meningioma resection.
  
  
  METHODS
  In 52 consecutive patients admitted for meningioma surgery, serum S100beta levels were determined upon admission and immediately, 24 hours, and 48 hours after surgery. All patients underwent complete pre- and postoperative neurological examination and mini-mental state examination. Radiological evaluation included preoperative magnetic resonance imaging (MRI) and postoperative computed tomography. Tumour volume, brain edema, and bleeding volume were calculated using BrainSCAN software.
  
  
  RESULTS
  Preoperative S100beta levels did not correlate with the tumour characteristics demonstrated by preoperative MRI (for example, tumour volume, edema volume, ventricular asymmetry, and/or midline shift). Preoperative serum S100beta levels (0.065 +/- 0.040 microg/l) were significantly lower than the levels measured immediately (0.138 +/- 0.081 microg/l), 24 hours (0.142 +/- 0.084 microg/l), and 48 hours (0.155 +/- 0.119 microg/l) postoperatively (p < 0.0001). Significantly greater postcraniotomy S100beta levels were observed with prolonged surgery (p = 0.039), deterioration in the mini-mental state examination (p = 0.005, 0.011, and 0.036 for pre versus immediate, 24 hours, and 48 hours postsurgery, respectively), and with postoperative brain computed tomography evidence of brain injury; bleeding was associated with higher serum S100beta levels at 24 and 48 hours after surgery (p = 0.046, 95% confidence interval [CI] -0.095 to -0.001 and p = 0.034, 95% CI -0.142 to -0.006, respectively) as was the presence of midline shift (p = 0.005, 95% CI -0.136 to -0.025 and p = 0.006, 95% CI -0.186 to -0.032, respectively). Edema was associated with higher serum S100beta levels immediately (p = 0.022, 95% CI -0.092 to -0.007) and at 48 hours after surgery (p = 0.017, 95% CI -0.142 to -0.026). The degree of elevation in S100beta levels at 24 and 48 hours after surgery also correlated with the severity of midline shift and edema.
  
  
  CONCLUSIONS
  In patients with meningioma, serum S100beta levels perform poorly as an indicator of tumour characteristics but may suggest ongoing postcraniotomy injury. Serum S100beta levels may serve as a potentially useful early marker of postcraniotomy brain damage in patients undergoing elective meningioma resection.
authors.affiliation: General Intensive Care Unit, Shaare Zedek Medical Centre (affiliated with the Faculty of Health Sciences of the Ben-Gurion University), PO Box 3235, Jerusalem 91031, Israel. einav_s@szmc.org.il
authors.forename: Sharon
authors.initials: S
authors.lastname: Einav
authors.forename: Yigal
authors.initials: Y
authors.lastname: Shoshan
authors.forename: Haim
authors.initials: H
authors.lastname: Ovadia
authors.forename: Idit
authors.initials: I
authors.lastname: Matot
authors.forename: Moshe
authors.initials: M
authors.lastname: Hersch
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001925:Brain Damage, Chronic / Q000097:blood* / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human