Correlation of systemic protein S100β levels with postoperative indicators of neurological damage in supratentorial meningioma surgery

Background

Elevated plasma levels of S100β, an astrocyte-derived protein, correlate with neurological deterioration after cardiac surgery [1] and with poor survival following hypoxia [2] and neurotrauma [3] but remain unexplored during elective meningioma surgery. We hypothesized that S100β levels correlate with this tumor's preoperative characteristics and with perioperative neurological injury despite its supratentorial location and non-neural origin.

Methods

All patients admitted for meningioma surgery (1 January 2004–31 October 2004) underwent prospective perioperative clinical/radiographic (CT, MRI) neurological evaluation. S100β levels were drawn upon admission and at 2, 24 and 48 hours postoperatively and correlated with clinical/radiological characteristics.

Results

Included were 52 patients aged 58.5 ± 13 years (median 60, range 30–80 years), mostly female (40/52). Preoperative mini-mental scores averaged 26.6 ± 6.8 (median 29.5, minimum 11). Several meningiomas were recurrent (14/52) and/or had been irradiated (16/52). MRI demonstrated a mass effect in 35/52 patients. Average tumor and edema volumes were 35.29 ± 29.39 cm² and 24.83 ± 32.39 cm², respectively. Surgery was usually performed via pterional/frontal approaches and averaged 5 hours. Postoperative CT demonstrated infarct in three patients and bleeding (average volume 1.13 ± 4.19 cm², median 0, maximum 29.68 cm²) in 22 patients. Preoperative S100β levels did not correlate with tumor characteristics. S100β levels rose postoperatively and remained elevated (Fig. 1). Greater elevations of S100β were associated with poor quality of the surgical plane at 2 hours (P = 0.01), deterioration in the postoperative mini-mental score at 2 hours (P = 0.008) and at 24 hours (P = 0.017), and postoperative bleeding at 24 hours (P = 0.046) and 48 hours (P = 0.034).

Figure 1

Systemic S100β levels (presented as average ìg/l with 95% confidence intervals); preoperative, immediately postoperative, 24 and 48 hours after surgery.

Conclusion

Systemic S100β levels perform poorly as a tumor marker for patients with meningioma but provide early prediction of postoperative neurological injury following meningioma surgery.