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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Impact of ischemic preconditioning on surgical treatment of brain tumors: a single-center randomized, double-blind, controlled trail

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  • Melanie Barz - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Arthur Ha Sales - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, München, Deutschland
  • Stefanie Bette - Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Florian Ringel - Mainz, Deutschland
  • Yu-MI Ryang - München, Deutschland
  • Martin Brettschneider - München, Deutschland
  • Jens Gempt - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.28.05

doi: 10.3205/17dgnc173, urn:nbn:de:0183-17dgnc1730

Published: June 9, 2017

© 2017 Barz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Postoperative ischemia is a frequent phenomenon in patients with brain tumors and is also responsible for many cases of postoperative neurological deficits. Particularly in the field of cardiac surgery, but also in other fields, it has been shown that the application of a brief ischemic stimulus not only in the target organ but also in a remote tissue can prevent ischemia in some patients. We hypothesized that remote ischemic preconditioning (rIPC) in patients with glioma and metastasis undergoing surgical resection reduces the incidence of postoperative ischemic events and its consequences.

Methods: Randomization of 60 patients in two study arms (ratio 1:1) stratified to previous treatment with radiotherapy. Induction of ischemic preconditioning: A blood pressure cuff was placed on the upper arm and inflated three times for 5 minutes at 200 mmHg in the treatment group after induction of anesthesia. Between the cycles, the blood pressure cuff was released to allow reperfusion. In the placebo group no intervention has been performed. Early postoperative MRI images were evaluated for the presence of ischemia and its volume.

Results: Fifty-eight patients were evaluated for occurrence of postoperative ischemia. Early postoperative MRI was not performed in 2 patients in the rIPC group. One patient died within 48 hours after surgery due to clinical complications and comorbidities. In an additional patient, there were technical problems during images acquisition. Of these 58 patients, 44 (75,9%) had new postoperative ischemic lesions. The incidence of new postoperative ischemic lesions was significantly higher in the control group (87,1%) (27 of 31 patients) than in the rIPC group (63%) (17 of 27 patients) (p=0,03). The median infarct volume was 1,24 cm3 (IR: 0,59- 3,74) in the rIPC group compared with 1,58 cm3 (IR: 0,43- 3,73) in the control group (p=0,87).

Conclusion: rIPC reduced the incidence of postoperative ischemic events in patients with brain tumors. We have not found a significant association between ischemic preconditioning and infarct volume. Further randomized trials with a larger sample size are necessary to evaluate the influence of rIPC on reduction of infarct volume.