Dysregulation of immune response following neurosurgical operations

Background: Postoperative infections are common and potentially fatal compl ications in neurosurgical intensive care medicine. An impairment of immune function has been described after central nervous system surgery and in pat ients harboring malignant brain tumors. The aim of our study was to investi gate whether differences in cell-mediated immunity can be found in patients undergoing craniotomy for surgery of glioblastoma or dipping of an intrace rebral aneurysm. Methods: In order to determine the influence of the underlying disease on t he immune system, we measured changes in cytokine concentrations (IL-6, IL- 10, TGF-beta1) and lymphocyte-subsets (CD3+, CD3+HLA-DR+, CD4+, CD8+, CD19, and CD16+56+) in 8 patients with glioblastoma and in 8 patients with an i ntracerebral aneurysm before, during and after the neurosurgical procedure. Results: In the comparison of glioblastoma and aneurysm patients, we could show that IL-6 plasma levels were pre- and intraoperatively higher in the a neurysm-group (P<0.05), and the plasma concentrations of IL-10 and TGF-beta were significantly elevated in the glioma-group. The lymphocyte-subsets sh owed a significantly lower percentage of NK-cells and activated T-cells in the glioma-group. Conclusion: Our results document a significant dysregulation of immune resp onse in glioma patients. This may be induced by elevated plasma concentrati ons of immunoinhibiting cytokines IL-10 and transforming growth factor-beta 1.