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01.12.2014 | Clinical Article - Brain Tumors | Ausgabe 12/2014

Acta Neurochirurgica 12/2014

Perioperative microdialysis in meningioma surgery: correlation of cerebral metabolites with clinical outcome

Zeitschrift:
Acta Neurochirurgica > Ausgabe 12/2014
Autoren:
Christina Balaka, George Stranjalis, Theodosis Kalamatianos, Christos Koutsarnakis, Triantafyllos Bouras, Efstathios Boviatsis, Damianos E. Sakas
Wichtige Hinweise

Comment

The authors present pioneering work regarding postoperative monitoring of patients undergoing craniotomy for meningioma surgery. It seems that the authors were able to determine a pivotal time point in the early postoperative course separating worse from better outcomes by the means of intra- and postoperative microdialysis of the cerebral extracellular space. At 8 h postoperatively, the authors found significant metabolic changes indicative of problems that could not be detected by early postoperative CT scans at 24 h postoperatively. If those findings can be reproduced, several questions need to be addressed. What is the exact pathophysiological nature of the early postoperative changes in cerebral metabolism in patients with an unfavourable postoperative outcome? What can be done clinically to intervene once those changes become evident? Should patients undergo an MRI at the time such diagnostic metabolic changes are detected? It seems that microdialysis may bridge the neurological monitoring gap that lies between skin closure and an early postoperative CT scan or MRI performed at 24–48 h postoperatively. This time gap is usually bridged clinically by monitoring the patients’ Glasgow Coma Score. Judging from the authors’ data, it also seems that events in the early postoperative course that are not yet understood seem to play a decisive role in the postoperative outcome following craniotomy for tumour surgery. The authors have opened a new avenue of research in the early postoperative phase in such patients.
Thomas Mindermann
Zurich, Switzerland

Abstract

Background

Brain tumour resection requires surgical manoeuvres that may cause an ischaemic injury to peritumoral tissue. The aim of the present study was to examine whether putative alterations in peritumoral tissue biochemistry, monitored by microdialysis, correlate with clinical outcome in patients undergoing craniotomy for meningioma resection.

Methods

In 34 patients undergoing meningioma resection (35 % male; mean age ± SD: 54.3 ± 12.1 years), microdialysis measurements were taken perioperatively from peritumoral brain parenchyma. Standard metabolites (glucose, lactate, pyruvate, glycerol and the lactate:pyruvate ratio) were quantified in relation to clinical outcome assessed by the Glasgow Coma Scale (GCS) and the Karnofsky Performance Status scale.

Results

Higher postoperative glucose and pyruvate levels were found in patients with a favourable outcome (GCS not deteriorated or Karnofsky score >80). Multiple logistic regression analysis (age, preoperative physical status, metabolite levels as independent variables) showed that lower postoperative glucose and pyruvate levels as well as higher lactate:pyruvate ratio values were independently associated with an unfavourable outcome as defined by Karnofsky score <80 [(OR: 0.084, 95 % CI: 0.01–0.98, p = 0.049), (OR: 0.97, 95 % CI: 0.95–0.99, p = 0.050), (OR: 1.21, 95 % CI: 1.04–1.42, p = 0.015) respectively], as well as with death [(OR: 0.08, 95 % CI: 0.01–0.97, p = 0.046), (OR: 0.94, 95 % CI: 0.89–0.99, p = 0.016), (OR: 1.07, 95 % CI: 1.00–1.15, p = 0.05) respectively].

Conclusions

Postoperative levels of glucose and pyruvate and the lactate:pyruvate ratio appear to correlate with clinical outcome in patients undergoing meningioma resection. The present findings provide support for the utility of microdialysis as a prognostic tool in brain tumour surgery.

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