Deepak Agrawal, Nilesh S. Kurwale, Bhawani S. Sharma

Department of Neurosurgery and gamma knife

All India Institute of Medical SciencesNew Delhi - 110029

Intra operative brain handling

Anticipation of complications

Need for a marker

Novel concept

Prospective randomized study

September 2006 to march 2007

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Inclusion criteria: a) All routine craniotomies with operative duration of more

than 3 hrs.

Exclusion criteria:a) Patients having fever in post operative period or study

period till fifth post op day.b) Documented infection in preop period.

Two groups

Craniotomy for tumor excision.

Craniotomy for aneurysm surgery.

Morning TLC counts of first five post operative days.

A ratio “R” for each day was calculated.

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TLC COUNT(DAY)

RDAY = ------ ---------------------- PREOP TLC COUNT

Spss version 10

Analysis using student “t” test, adjusted analysis and analysis with repeated measures were done where ever necessary.

P ≤ 0.05 and CI of 95%

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parameters Tumor group Aneurysm group

Number of patients 46 30

Mean age 34.2 43.60

Sex (m/f) 30/16 16/14

Preoperative steroids 38 00

Intra operative parameter.

Tumor group Aneurysm group

Mean operative time (min)

253 247

Mean input (ml) 3853 4140

Mean output (ml) 1492 1663

Mean blood loss (ml) 821 475

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Serial no. Primary diagnosis Number of patients

1 Glioma 21

2 Post fossa tumors 7

3 Contusions 6

4 Others 12

Spectrum of tumor group

TUMOR GROUP

Post operative days TLC values Ratios (tlc/preop tlc)

PREOP 11070 ± 3390 1.00 ± 0.00

Day 1 11640 ± 4471 1.10 ± 0.53

Day 2 12983 ± 7819 1.24 ± 0.76

Day 3 13130 ± 7705 1.27 ± 0.81

Day 4 11856 ± 6454 1.17 ± 0.65

Day 5 11300 ± 5455 1.13 ± 0.66

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S-100B in trauma

IL6 and CRP in stroke

Cytokines and TNF- α in stroke

Easy and reproducible

Cost effective

Convenient and easily available at every place.

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Total leukocyte counts correlates with the intraoperative brain handling and injury

It follows a specific pattern in early postoperative days.

Brain inflicts inflammatory reaction whenever blood brain barrier is broken.

TLC counts in the early postoperative days should be interpreted cautiously as a evidence of infection.

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