Leukocytosis as a biomarker for brain injury after cranial surgery
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Transcript of Leukocytosis as a biomarker for brain injury after cranial surgery
Deepak Agrawal, Nilesh S. Kurwale, Bhawani S. Sharma
Department of Neurosurgery and gamma knife
All India Institute of Medical SciencesNew Delhi - 110029
Intra operative brain handling
Anticipation of complications
Need for a marker
Novel concept
Prospective randomized study
September 2006 to march 2007
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Inclusion criteria: a) All routine craniotomies with operative duration of more
than 3 hrs.
Exclusion criteria:a) Patients having fever in post operative period or study
period till fifth post op day.b) Documented infection in preop period.
Two groups
Craniotomy for tumor excision.
Craniotomy for aneurysm surgery.
Morning TLC counts of first five post operative days.
A ratio “R” for each day was calculated.
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TLC COUNT(DAY)
RDAY = ------ ---------------------- PREOP TLC COUNT
Spss version 10
Analysis using student “t” test, adjusted analysis and analysis with repeated measures were done where ever necessary.
P ≤ 0.05 and CI of 95%
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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
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
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Serial no. Primary diagnosis Number of patients
1 Glioma 21
2 Post fossa tumors 7
3 Contusions 6
4 Others 12
Spectrum of tumor group
TUMOR GROUP
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
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Neurocon Agra
S-100B in trauma
IL6 and CRP in stroke
Cytokines and TNF- α in stroke
Easy and reproducible
Cost effective
Convenient and easily available at every place.
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Total leukocyte counts correlates with the intraoperative brain handling and injury
It follows a specific pattern in early postoperative days.
Brain inflicts inflammatory reaction whenever blood brain barrier is broken.
TLC counts in the early postoperative days should be interpreted cautiously as a evidence of infection.
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