Could Cerebrospinal Fluid Biomarkers Offer Better Predictive Value for Spinal Cord Ischaemia Than Current Neuromonitoring Techniques During Thoracoabdominal Aortic Aneurysm Repair – A Systematic Review

Abstract

Objective Cerebrospinal fluid (CSF) drainage is a technique that has significantly reduced the incidence of spinal cord ischaemia (SCI). We present results of a systematic review to assess the literature on this topic in relation to thoracoabdominal aortic aneurysm repair (TAAR). Methods Major medical databases were searched to identify papers related to CSF biomarkers measured during TAAAR. Results Fifteen papers reported measurements of CSF biomarkers with 265 patients in total. CSF biomarkers measured included S-100ß, neuron-specific endolase (NSE), lactate, glial fibrillary acidic protein A (GFPa), Tau, heat shock protein 70 and 27 (HSP70, HSP27), and proinflammatory cytokines. Lactate and S-100ß were reported the most, but did not correlate with SCI, which was also the case with NSE and TAU. GFPa showed significant CSF level rises, both intra and postoperative in patients who suffered SCI and warrants further investigation, similar results were seen with HSP70, HSP27 and IL-8. Conclusions Although there is significant interest in this topic, there still remains a significant lack of high-quality studies investigating CSF biomarkers during TAAR to detect SCI. A large and multicentre study is required to identify the significant role of each biomarker.

Arteriogenesis of the Spinal Cord—The Network Challenge

“…In fields of complex aortic surgery, only a few studies evaluated the applicability of biomarkers to detect spinal cord ischemia. Regarding S-100β in the CSF, ambiguous results could be observed in the existent studies, as levels of S-100β were not significantly higher in some studies for patients who suffered from SCI compared to the control group [22]. NSE, a dominant enolase-isoenzyme found in neuronal and neuroendocrine tissues, is a 78 kD gamma-homodimer.…”

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…A systematic review of 14 studies on 321 pts by Choong et al of biochemical markers in the assessment of SCI in TAA repair demonstrated a dramatic rise of S100B proteins, neurone-specific enolase (NFL) and glial fibrillary acidic protein (GFAp) in CSF which may be of use [282]. In contrast, Harky et al who also performed a systematic review found that there is a lack of high-quality studies investigating CSF biomarkers during TAA repair to detect SCI [283].…”