• Russell E Anderson, Anders Winnerkvist, Lars-Olof Hansson, Olle Nilsson, Lars Rosengren, Göran Settergren, and Jarle Vaage.
• Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Stockholm, Sweden. russell.anderson@kirurgi.ki.se
• J. Cardiothorac. Vasc. Anesth. 2003 Oct 1;17(5):598-603.

ObjectiveTo investigate the clinical potential of several markers of spinal cord ischemia in cerebrospinal fluid (CSF) and serum during aneurysm repair of the descending thoracic or thoracoabdominal aorta.DesignObservational study of consecutive patients. Nonblinded, nonrandomized.SettingUniversity hospital thoracic surgical unit.ParticipantsEleven consecutive elective patients.InterventionsDistal extracorporeal circulation and maintenance of CSF pressure <10 mmHg until intrathecal catheter removal.Measurements And Main ResultsCSF and serum levels of S100B (and its isoforms S100A1B and S100BB), neuronal-specific enolase (NSE), and the CSF levels of glial fibrillary acidic protein (GFAp) and lactate were determined. Two patients had postoperative neurologic deficit. One with a stroke showed a 540-fold increased GFAp, a 6-fold NSE, and S100B increase in CSF. One with paraplegia had a 270-fold increase in GFAp, a 2-fold increase in NSE, and 5-fold increased S100B in CSF. One patient without deficit increased GFAp 10-fold, NSE 4-fold, and S100B 23-fold in CSF. CSF lactate increased >50% in 6 of 9 patients without neurologic deficit. Serum S100B increased within 1 hour of surgery in all patients without any concomitant increase in CSF. S100A1B was about 70% of total S100B in both serum and CSF in patients with or without neurologic defects. S100B in CSF increased 3-fold in 3 of 9 asymptomatic patients.ConclusionsIn patients with neurologic deficit, GFAp in CSF showed the most pronounced increase. Biochemical markers in CSF may increase without neurologic symptoms. There is a significant increase in serum S100B from surgical trauma alone without any increase in CSF.

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