Minim Invasive Neurosurg 2003; 46(1): 33-36
DOI: 10.1055/s-2003-37963
Original Article
© Georg Thieme Verlag Stuttgart · New York

Peri-Operative Levels of S-100 Protein in Serum: Marker for Surgical Manipulation and Postoperative Complications

J.  de Vries1 , S.  E. A.  Snels1 , T.  Menovsky1 , W.  A. J. G.  Lemmens3 , H.  de Reus2 , K.  J. B.  Lamers2 , J.  A.  Grotenhuis1
  • 1Department of Neurosurgery, University Medical Center St. Radboud, Nijmegen, The Netherlands
  • 2Department of Neurology, University Medical Center St. Radboud, Nijmegen, The Netherlands
  • 3Department of Medical Statistics, University Medical Center St. Radboud, Nijmegen, The Netherlands
Further Information

Publication History

Publication Date:
17 March 2003 (online)

Abstract

Although minimally invasive neurosurgical techniques are highly sophisticated nowadays, almost any operative procedure causes an inevitable surgical trauma to the brain. As a consequence unfavorable functional outcomes are not rare. Intraoperative biochemical monitoring can be helpful first to detect but also to prevent brain damage. We investigated if serum S-100 protein (S-100) levels are a reliable marker for the extent of acute cerebral damage caused by surgical trauma or postoperative complication. S-100 is present in the cytosol of glial cells. This protein leaks into the extracellular space after cell damage and can be detected both in the cerebrospinal fluid (CSF) and serum. To determine S-100 protein levels, serum samples from 20 patients with various intracranial tumors were collected before surgery, and at one day, as well as at seven days after surgery. It was hypothesised that the size of the tumor-brain contact surface (TBCS) was closely related to the dimension of the surgical trauma. TBCS was measured from radiological imaging. The pre- and postoperative (day 1 and day 7) clinical condition of each patient was assessed. The S-100 levels were correlated with the TBCS and the clinical condition. Levels of S-100 on day 1 and day 7 were significantly higher as compared with levels on day 0 (p = 0.02, respectively p = 0.01). There was a significant relationship between rise of S-100 level and worsening of clinical condition between day 0 and day 1 (p = 0.001). Also a significant positive relationship between TBCS and the level of S-100 could be found on day 1 and on day 7 (R = 0.71, p = 0.0009, respectively R = 0.73, p = 0.004). Furthermore, a significant relationship between the rise of S-100 level between day 0 and day 1, as well as between day 0 and day 7, and TBCS could be documented (R = 0.61, p = 0.01, respectively R = 0.64, p = 0.005). In conclusion, serum S-100 levels are a reliable marker for acute or recent CNS damage caused by neurosurgical manipulation or as a result of secondary postoperative complications. Therefore, intraoperative monitoring of serum S-100 levels seems very promising. In such a setting the negative effects of surgical manipulation can be measured instantaneously, which should bring the neurosurgeon to change his strategy. As a consequence the surgical trauma can be minimized and functional outcome can be optimized.

References

  • 1 Persson L, Hardemark H G, Gustafsson J, Rundstrom G, Mendel H I, Esscher T, Pahlman S. S-100 protein and neuron-specific enolase in cerebrospinal fluid and serum: markers of cell damage in human central nervous system.  Stroke. 1987;  18 911-918
  • 2 Sindic C J, Chalon M P, Cambiaso C L, Laterre E C, Masson P L. Assessment of damage to the central nervous system by determination of S-100 protein in the cerebrospinal fluid.  J Neurol Neurosurg Psychiatry. 1982;  45 1130-1135
  • 3 Abraha H D, Butterworth R J, Bath P MW, Wassif W S, Garthwaite J, Sherwood R A. Serum S-100 protein, relationship to clinical outcome in acute stroke.  Ann Clin Biochem. 1997;  34 366-370
  • 4 Rosen H, Rosengren L, Herlitz J, Blomstrand C. Increased serum levels of the S-100 protein are associated with hypoxic brain damage after cardiac arrest.  Stroke. 1998;  29 473-477
  • 5 Nooijen P T, Schoonderwaldt H C, Wevers R A, Hommes O R, Lamers K J. Neuron-specific enolase, S-100 protein, myelin basic protein and lactate in CSF in dementia.  Dement Geriatr Cogn Disord. 1997;  8 169-173
  • 6 Aurell A, Rosengren L E, Karlsson B, Olsson J E, Zbornikova V, Haglid K G. Determination of S-100 and glial fibrillary acidic protein concentrations in cerebrospinal fluid after brain infarction.  Stroke. 1991;  22 1254-1258
  • 7 van Engelen B, Lamers K J, Gabreels F J, van Wevers G W, Borm G F. Age related changes of neuron-specific enolase, S-100 protein, and myelin basic protein concentrations in cerebrospinal fluid.  Clin Chem. 1992;  38 813-816
  • 8 Ingebrigtsen T, Romner B, Kongstad P, Langbakk B. Increased serum concentrations of protein S-100 after minor head injury: a biochemical serum marker with prognostic value?.  J Neurol Neurosurg Psychiatr. 1995;  59 103-104
  • 9 Lamers K J, van Engelen E B, Gabreels F J, Hommes O R, Borm G F, Wevers R A. Cerebrospinal neuron specific enolase, S-100 and myelin basic protein in neurological disorders.  Acta Neurol Scand. 1995;  92 247-251
  • 10 Martens E, Raabe A, Johnsson P. Serum S-100 and neuron-specific enolase for prediction of regaining consciousness after global cerebral ischemia.  Stroke. 1998;  29 2363-2366
  • 11 de Vries J, Thijssen W AMH, Snels S AE, Menovsky T, Peer P GM, Lamers K JBl. Intraoperative values of S-100 protein, myelin basic protein, lactate and albumin in the CSF and serum of neurosurgical patients. Biochemical communication.  J Neurol Neurosurg Psychiatr. 2001;  71 671-674
  • 12 van Dongen E P, Ter Beek H, Boezeman E H. Normal serum concentrations of S100 protein and changes in cerebrospinal fluid concentrations of S-100 protein during and after thoracoabdominal aortic aneurysm surgery: Is S-100 protein a biochemical marker of clinical value in detecting spinal cord ischemia.  J Vasc Surg. 1998;  27 344-346

J. de Vries,M. D. 

Department of Neurosurgery · University Medical Center St. Radboud

PO Box 9101

6500 HB Nijmegen · The Netherlands

Phone: + 31-24-361-3477

Fax: + 31-24-354-1578 ·

Email: j.devries@nch.umcn.nl