Hypotension during transsphenoidal pituitary surgery associated with increase in plasma levels of brain injury markers

Martin Thorsson; Tobias Hallén; Daniel S Olsson; Kaj Blennow; Henrik Zetterberg; Gudmundur Johannsson; Thomas Skoglund; Jonatan Oras

doi:10.1111/aas.14315

Hypotension during transsphenoidal pituitary surgery associated with increase in plasma levels of brain injury markers

Acta Anaesthesiol Scand. 2023 Nov;67(10):1363-1372. doi: 10.1111/aas.14315. Epub 2023 Aug 3.

Authors

Martin Thorsson¹, Tobias Hallén², Daniel S Olsson^{3

4

5}, Kaj Blennow^{6

7}, Henrik Zetterberg^{6

7

8

9

10

11}, Gudmundur Johannsson^{3

4}, Thomas Skoglund², Jonatan Oras¹

Affiliations

¹ Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Department of Neurosurgery, Sahlgrenska University Hospital, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden.
⁴ Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ Late-stage Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, Mölndal, Sweden.
⁶ Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
⁷ Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
⁸ Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.
⁹ UK Dementia Research Institute at UCL, London, UK.
¹⁰ Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China.
¹¹ Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.

PMID: 37534390
DOI: 10.1111/aas.14315

Abstract

Background: Patients undergoing pituitary surgery may experience short- and long-term postoperative morbidity. Intraoperative factors such as hypotension might be a contributing factor. Our aim was to investigate the association between intraoperative hypotension and postoperative plasma levels of tau, neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) as markers of perioperative brain injury.

Methods: Between June 2016 and October 2017, 35 patients from the Gothenburg Pituitary Tumor Study were included. For tau, NfL, and GFAP, concentrations were measured in plasma samples collected before and immediately following surgery, and on postoperative days 1 and 5. The difference between the highest postoperative value and the value before surgery was used for analysis (∆tau_peak , ∆NfL_peak , ∆GFAP_peak ). Intraoperative hypotension was defined as the area under the curve of an absolute threshold below 70 mmHg (AUC70) and a relative threshold below 20% (AUC20%) of the baseline mean arterial blood pressure.

Results: Plasma tau and GFAP were highest immediately following surgery and on day 1, while NfL was highest on day 5. There was a positive correlation between AUC20% and both ∆tau_peak (r² = .20, p < .001) and ∆NfL_peak (r² = .26, p < .001). No association was found between AUC20% and GFAP or between AUC70 and ∆tau_peak , ∆NfL_peak or ∆GFAP_peak .

Conclusion: Intraoperative relative, but not absolute, hypotension was associated with increased postoperative plasma tau and NfL concentrations. Patients undergoing pituitary surgery may be vulnerable to relative hypotension, but this needs to be validated in future prospective studies.

Keywords: biomarkers; hypotension; neurosurgery; pituitary tumors.

Abstract

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