Leukocytosis as a biomarker for brain injury after cranial surgery

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Leukocytosis as a biomarker for brain injury after cranial surgery

  1. 1. <ul><li>Deepak Agrawal, Nilesh S. Kurwale, Bhawani S. Sharma </li></ul><ul><li>Department of Neurosurgery and gamma knife </li></ul><ul><li>All India Institute of Medical Sciences </li></ul><ul><li>New Delhi - 110029 </li></ul>
  2. 2. <ul><li>Intra operative brain handling </li></ul><ul><li>Anticipation of complications </li></ul><ul><li>Need for a marker </li></ul><ul><li>Novel concept </li></ul>
  3. 3. <ul><li>Prospective randomized study </li></ul><ul><li>September 2006 to march 2007 </li></ul>Neurocon Agra
  4. 4. <ul><li>Inclusion criteria: </li></ul><ul><ul><li>All routine craniotomies with operative duration of more than 3 hrs. </li></ul></ul><ul><li>Exclusion criteria: </li></ul><ul><ul><li>Patients having fever in post operative period or study period till fifth post op day. </li></ul></ul><ul><ul><li>Documented infection in preop period. </li></ul></ul>
  5. 5. <ul><li>Two groups </li></ul><ul><ul><li>Craniotomy for tumor excision. </li></ul></ul><ul><ul><li>Craniotomy for aneurysm surgery. </li></ul></ul>
  6. 6. <ul><li>Morning TLC counts of first five post operative days. </li></ul><ul><li>A ratio “R” for each day was calculated. </li></ul>Neurocon Agra TLC COUNT (DAY) R DAY = ------ ---------------------- PREOP TLC COUNT
  7. 7. <ul><li>Spss version 10 </li></ul><ul><li>Analysis using student “t” test, adjusted analysis and analysis with repeated measures were done where ever necessary. </li></ul><ul><li>P ≤ 0.05 and CI of 95% </li></ul>Neurocon Agra
  8. 8. parameters Tumor group Aneurysm group Number of patients 46 30 Mean age 34.2 43.60 Sex (m/f) 30/16 16/14 Preoperative steroids 38 00
  9. 9. Neurocon Agra Intra operative parameter. Tumor group Aneurysm group Mean operative time (min) 253 247 Mean input (ml) 3853 4140 Mean output (ml) 1492 1663 Mean blood loss (ml) 821 475
  10. 10. Spectrum of tumor group Serial no. Primary diagnosis Number of patients 1 Glioma 21 2 Post fossa tumors 7 3 Contusions 6 4 Others 12
  11. 11. TUMOR GROUP
  12. 12. Neurocon Agra Post operative days TLC values Ratios (tlc/preop tlc) PREOP 11070 ± 3390 1.00 ± 0.00 Day 1 11640 ± 4471 1.10 ± 0.53 Day 2 12983 ± 7819 1.24 ± 0.76 Day 3 13130 ± 7705 1.27 ± 0.81 Day 4 11856 ± 6454 1.17 ± 0.65 Day 5 11300 ± 5455 1.13 ± 0.66
  13. 13. Neurocon Agra
  14. 15. <ul><li>S-100B in trauma </li></ul><ul><li>IL6 and CRP in stroke </li></ul><ul><li>Cytokines and TNF- α in stroke </li></ul>
  15. 16. <ul><li>Easy and reproducible </li></ul><ul><li>Cost effective </li></ul><ul><li>Convenient and easily available at every place. </li></ul>Neurocon Agra
  16. 17. <ul><li>Total leukocyte counts correlates with the intraoperative brain handling and injury </li></ul><ul><li>It follows a specific pattern in early postoperative days. </li></ul>
  17. 18. <ul><li>Brain inflicts inflammatory reaction whenever blood brain barrier is broken. </li></ul><ul><li>TLC counts in the early postoperative days should be interpreted cautiously as a evidence of infection. </li></ul>Neurocon Agra

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