gms | German Medical Science

Biochemical substances such as S-100B protein or glial fibrillary acidic protein (GFAP) may be used as specific markers of brain cell damage. This report demonstrates the intraoperative use of two promising neurochemical markers for diagnosis and monitoring of possible brain infarct during a complex neurosurgical procedure.

A 45-year-old man with acute subarachnoid haemorrhage (Fisher grade III, Hunt and Hess grade III) from a giant aneurysm at the bifurcation of right middle cerebral artery (2.2x3 cm) underwent surgical clipping under circulatory arrest and deep hypothermia (19°C). Perioperatively serum S-100B and GFAP were measured for baseline values and during operation every hour.

The giant aneurysm was occluded by positioning 8 Sugitta-clips during two short periods of circulatory arrest. S-100B (normal values <0.12 µg/L) increased temporarily to a pathological level (0.36 µg/L) after the beginning of the first circulatory arrest and during the microsurgical clipping of the aneurysm. After the second arrest and clipping S-100B had already returned to normal levels. GFAP (normal values <0,3 µg/L) increased later than S-100B, but to a much higher level (1.56 mg/L). The clinical outcome of the patient after 6 months was excellent.

Monitoring and analysis of the time course of biochemical markers may help to identify critical events during neurosurgical procedures. Given the high sensitivity of S-100B for indicating brain damage, the temporal course of S-100B in our case indicates a pathological event during the first circulatory arrest and aneurysm dissection, but excludes a major brain damage because the levels quickly returned to normal. The short-term course of the new molecular marker GFAP demonstrates a close correlation to S-100B. Further studies are necessary to investigate the potential use of serum GFAP as a marker of brain damage and for the correct interpretation.