Impact of ischemic preconditioning on surgical treatment of brain tumors: A single-center, randomized, double-blind, controlled trial

Arthur H.A. Sales, Melanie Barz, Stefanie Bette, Benedikt Wiestler, Yu Mi Ryang, Bernhard Meyer, Martin Bretschneider, Florian Ringel, Jens Gempt

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: Postoperative ischemia is a frequent phenomenon in patients with brain tumors and is associated with postoperative neurological deficits and impaired overall survival. Particularly in the field of cardiac and vascular surgery, the application of a brief ischemic stimulus not only in the target organ but also in remote tissues can prevent subsequent ischemic damage. We hypothesized that remote ischemic preconditioning (rIPC) in patients with brain tumors undergoing elective surgical resection reduces the incidence of postoperative ischemic tissue damage and its consequences. Methods: Sixty patients were randomly assigned to two groups, with 1:1 allocation, stratified by tumor type (glioma or metastasis) and previous treatment with radiotherapy. rIPC was induced by inflating a blood pressure cuff placed on the upper arm three times for 5min at 200mmHg in the treatment group after induction of anesthesia. Between the cycles, the blood pressure cuff was released to allow reperfusion. In the control group no preconditioning was performed. Early postoperative magnetic resonance images (within 72h after surgery) were evaluated by a neuroradiologist blinded to randomization for the presence of ischemia and its volume. Results: Fifty-eight of the 60 patients were assessed for occurrence of postoperative ischemia. Of these 58 patients, 44 had new postoperative ischemic lesions. The incidence of new postoperative ischemic lesions was significantly higher in the control group (27/31) than in the rIPC group (17/27) (p=0.03). The median infarct volume was 0.36cm3 (interquartile range (IR): 0.0-2.35) in the rIPC group compared with 1.30cm3 (IR: 0.29-3.66) in the control group (p=0.09). Conclusions: Application of rIPC was associated with reduced incidence of postoperative ischemic tissue damage in patients undergoing elective brain tumor surgery. This is the first study indicating a benefit of rIPC in brain tumor surgery. Trial registration: German Clinical Trials Register, DRKS00010409. Retrospectively registered on 13 October 2016.

Original languageEnglish
Article number137
JournalBMC Medicine
Volume15
Issue number1
DOIs
StatePublished - 25 Jul 2017
Externally publishedYes

Keywords

  • Brain metastasis
  • Brain tumor
  • Glioma
  • Ischemic preconditioning
  • Neurooncology
  • Neurosurgery
  • Stroke

Fingerprint

Dive into the research topics of 'Impact of ischemic preconditioning on surgical treatment of brain tumors: A single-center, randomized, double-blind, controlled trial'. Together they form a unique fingerprint.

Cite this