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Published on: October 28, 2022
Lipid Peroxidation and Antioxidant Consumption as Early Markers of Neurosurgery-Related Brain Injury in Children
M Piastra1,2, E Caresta1,3,4, L Massimi5
1Pediatric Intensive Care Unit, Department of Emergency, Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Gemelli 8, 00168, Rome, Italy.
Insights
Lipid peroxidation increases in cerebrospinal fluid after pediatric brain surgery, indicating secondary injury. Monitoring malondialdehyde (MDA) levels may help assess patient outcomes.
Area of Science:
- Neuroscience
- Biochemistry
- Pediatric Surgery
Background:
- Lipid peroxidation is a marker of secondary brain injury after neurosurgery.
- Malondialdehyde (MDA) and ascorbate are key indicators of oxidative stress in cerebrospinal fluid (CSF).
Purpose of the Study:
- To measure changes in cerebral lipid peroxidation ex vivo in children undergoing neurosurgery.
- To investigate the relationship between oxidative stress markers and clinical outcomes.
Main Methods:
- Collected plasma and CSF samples from 36 children post-neurosurgery.
- Serially measured malondialdehyde (MDA), ascorbate, and cytokines.
- Correlated oxidative markers with tumor characteristics and clinical parameters.
Main Results:
- Increased MDA and decreased ascorbate in CSF post-surgery, indicating heightened lipid peroxidation.
- Systemic inflammation evidenced by increased IL-6/IL-8 in plasma.
- Elevated postoperative CSF MDA correlated with longer ventilation needs.
Conclusions:
- Lipid peroxidation consistently increases after brain surgery, alongside reduced antioxidant defenses.
- Intraventricular catheters provide a monitoring opportunity for oxidative stress.
- Further research is needed to determine the prognostic value of monitoring CSF oxidative stress.
Background And Aims:
Lipid peroxidation represents a marker of secondary brain injury both in traumatic and in non-traumatic conditions-as in major neurosurgical procedures-eventually leading to brain edema amplification and further brain damage. Malondialdehyde (MDA), a lipid peroxidation marker, and ascorbate, a marker of antioxidant status, can represent early indicators of this process within the cerebrospinal fluid (CSF). We hypothesized that changes in cerebral lipid peroxidation can be measured ex vivo following neurosurgery in children.
Methods:
Thirty-six children (M:F = 19/17, median age 32.9 months; IQR 17.6-74.6) undergoing neurosurgery for brain tumor removal were admitted to the pediatric intensive care unit (PICU) in the postoperative period with an indwelling intraventricular catheter for intracranial pressure monitoring and CSF drainage. Plasma and CSF samples were obtained for serial measurement of MDA, ascorbate, and cytokines.
Results:
An early brain-limited increase in lipid peroxidation was measured, with a significant increase from baseline of MDA in CSF (p = 0.007) but not in plasma. In parallel, ascorbate in CSF decreased (p = 0.05). Systemic inflammatory response following brain surgery was evidenced by plasma IL-6/IL-8 increase (p 0.0022 and 0.0106, respectively). No correlation was found between oxidative response and tumor site or histology (according to World Health Organization grading). Similarly, lipid peroxidation was unrelated to the length of surgery (mean 321 ± 73 min), or intraoperative blood loss (mean 20.9 ± 16.8% of preoperative volemia, 44% given hemotransfusions). Median PICU stay was 3.5 days (IQL range 2-5.5 d.), and postoperative ventilation need was 24 h (IQL range 20-61.5 h). The elevation in postoperative MDA in CSF compared with preoperative values correlated significantly with postoperative ventilation need (P = 0.05, r2 0168), while no difference in PICU stay was recorded.
Conclusions:
Our results indicate that lipid peroxidation increases consistently following brain surgery, and it is accompanied by a decrease in antioxidant defences; intraventricular catheterization offers a unique chance of oxidative process monitoring. Further studies are needed to evaluate whether monitoring post-neurosurgical oxidative stress in CSF is of prognostic utility.
