Proinflammatory cytokines in cerebrospinal fluid in repair of thoracoabdominal aorta

Background. Little is known about alterations of cytokine levels in cerebro spinal fluid (CSF) during thoracoabdominal aortic surgery. We measured peri operative CSF cytokine levels to determine their clinical significances. Methods. Perioperative serum and CSF levels of cytokine were measured in 15 adult patients undergoing repair of the descending thoracic aorta (n = 4) or thoracoabdominal aorta (n = II). All patients underwent prosthetic repla cement and perioperative CSF drainage. Serum and CSF levels of tumor necros is factor-alpha, Interleukin- (IL-) I beta, IL-6, IL-8, IL-10, and IL-12 we re measured before operation and at 0, 6, 12, 18, 24, 48, and 72 hours post operatively using enzyme-linked immunosorbent assays. Results. There were no hospital deaths, but 1 patient suffered paraplegia, Cerebrospinal fluid IL-8 levels peaked at immediately after operation (751. 7 +/- 42.1 pg/mL versus preoperative levels, 54.9 +/- 24.6 pg/mL; p < 0.001 ), and the higher levels persisted for 72 hours. In contrast, serum IL-8 le vels did not change and remained lower than CSF levels. The patient with pa raplegia had the highest CSF IL-8 levels throughout the study period. Serum and CSF levels of tumor necrosis factor-<alpha>, IL-1 beta, IL-6, and IL-1 2 did not significantly change. Serum and CSF levels of IL-10 were signific antly elevated after operation compared with preoperative levels. In contra st to IL-8, serum IL-10 levels surpassed CSF levels. Conclusions. Cerebrospinal fluid IL-8 levels are significantly elevated in thoracoabdominal aortic operation, and may be the most sensitive to the inf lammatory response in the ischemic spinal cord injury. Persistent elevation of CSF IL-8 levels may be predictive of further development of neurologic deficits, and a reduction of proinflammatory cytokine levels may be a benef icial effect of CSF drainage, but this requires further investigation. (C) 2001 by The Society of Thoracic Surgeons.