Stranjalis George, Korfias Stefanos, Psachoulia Christina, Boviatsis Efstathios, Kouyialis Andreas, Protopappa Despina, Sakas Damianos E
Departments of Neurosurgery, University of Athens, Athens, Greece.
Clin Chem. 2005 Jan;51(1):202-7. doi: 10.1373/clinchem.2004.039719. Epub 2004 Nov 18.
S-100B protein is an established serum marker of primary and secondary brain damage in head injury and stroke. Despite major progress in neurophysiologic monitoring, there are still difficulties in the early identification and quantification of evolving edema or trauma after craniotomy for tumor. In this study we aimed to correlate serum S-100B values with early postoperative neurologic course as well as late outcome in meningioma surgery.
We enrolled 50 consecutive patients who underwent meningioma resection. Serum S-100B was measured preoperatively and postcraniotomy for 7 consecutive days. Twenty-five patients (50%) developed immediate postoperative neurologic deterioration, and 15 (30%) had unfavorable 6-month outcomes. We used the Mann-Whitney U-test to assess the association of S-100B with all variables of interest. We used multiple logistic regression to search for the most significant predictor of postoperative deterioration.
Increased S-100B was highly correlated with larger tumors, intraoperative difficulties, postcraniotomy acute deterioration, and long-term poor outcome. In addition, multiple logistic regression showed that age, sex, site, preoperative edema, history of meningioma resection, extent of resection, and histologic type did not correlate with postoperative increases in S-100B. Furthermore, patients with postoperative S-100B values >0.4 microg/L had increased risk of deterioration (relative risk = 9.0; 95% confidence interval, 2.4-34; P <0.0001) and of poor ultimate outcome (relative risk = 11; 95% confidence interval, 1.6-77; P = 0.002).
After meningioma excision, postcraniotomy increases in serum S-100B appear to be an early indicator of short-term postoperative neurologic deterioration and of a poor longer-term outcome.
S-100B蛋白是颅脑损伤和中风中原发性和继发性脑损伤的一种公认的血清标志物。尽管神经生理监测取得了重大进展，但在开颅肿瘤切除术后早期识别和量化不断发展的水肿或创伤仍存在困难。在本研究中，我们旨在将血清S-100B值与脑膜瘤手术术后早期神经病程以及晚期预后相关联。
我们纳入了50例连续接受脑膜瘤切除术的患者。术前及开颅术后连续7天测量血清S-100B。25例患者（50%）术后立即出现神经功能恶化，15例（30%）6个月预后不良。我们使用Mann-Whitney U检验来评估S-100B与所有感兴趣变量之间的关联。我们使用多元逻辑回归来寻找术后恶化的最显著预测因素。
S-100B升高与肿瘤较大、术中困难、开颅术后急性恶化以及长期不良预后高度相关。此外，多元逻辑回归显示年龄、性别、部位、术前水肿、脑膜瘤切除史、切除范围和组织学类型与术后S-100B升高无关。此外，术后S-100B值>0.4μg/L的患者恶化风险增加（相对风险=9.0；95%置信区间，2.4 - 34；P<0.0001），最终预后不良的风险增加（相对风险=11；95%置信区间，1.6 - 77；P = 0.002）。
脑膜瘤切除术后，开颅术后血清S-100B升高似乎是术后短期神经功能恶化和长期预后不良的早期指标。
