Postoperative neurocognitive function and microembolus  detection in patients undergoing neck dissection:  a pilot study.
OBJECTIVE
Patients undergoing oncologic neck dissection may have many of the risk factors for carotid artery stenosis, thus predisposing them to perioperative cerebral ischaemic events. The present study was designed to investigate development of postoperative neurocognitive dysfunction in these patients.


METHODS
Twenty-six patients were assessed the day before surgery and 48 h and 12 months after surgery using a comprehensive neuropsychological test battery. Cognitive performance was compared with a matched control group to account for the practise effect associated with repeated testing. Doppler ultrasonography was used to detect intraoperative cerebral microembolism. S100beta protein values were evaluated before and immediately after anaesthesia.


RESULTS
On the second postoperative day, 26.9% of patients undergoing neck dissection had postoperative neurocognitive deficit (POCD), defined as a total deficit score of 2SD worse than the mean performance in the control group. Microemboli were found only in the neck dissection group. S100beta levels were significantly higher after neck dissection (Wilcoxon signed ranked test: P<0.001). After 12 months, the incidence of POCD was similar in both groups.


CONCLUSIONS
POCD was detectable only after neck dissection in the early postoperative period accompanied by increased incidence of microembolism and protein S100beta levels, but not 12 months after surgery.
Leiendecker
Jörn
J
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. leiendecker@anaesthesie.uni-kiel.de
Höcker
Jan
J
Meybohm
Patrick
P
Fudickar
Axel
A
Bein
Berthold
B
D000768:Anesthesia, General / Q000379:methods; D002545:Brain Ischemia / Q000378:metabolism; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects*; D009414:Nerve Growth Factors / Q000378:metabolism; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D012307:Risk Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins