| BackgroundIt is well known that opening the dura mater represents a critical moment during craniotomy for brain tumors. Cerebral swelling through the craniotomy can seriously increase the risk of cerebral ischemia with possible worsening of the outcome. Meningiomas, which constitute 15% of primary brain tumors in adults, are extraaxial, slow-growing, and histologically mostly benign ,Meningioma-associated edema ranged from 45% to 92% across different studies。Accordingly, decompression by craniotomy and tumor excision may cause the ischemic-reperfusion injury in patients with meningioma. Many perioperative neuronal protective methods, such as the modification of the surgical or anesthetic technique, the induction of hypothermia, or the administration of neuroprotective compounds have been introduced in passed decades. However, a reliable prophylaxis method is needed for attenuating the neuronal injury caused by ischemic-reperfusion injury during the craniotomy.Remote ischemic preconditioning (RIPC) reduces injury caused by ischemia-reperfusion in distant organs. RIPC has been proved to be protective against ischemia-reperfusion injury in brain, heart, liver, kidney, spinal cord, gut, and etc in many animal studies. Quite a few clinical trials have recently reported that remote ischemic preconditioning reduces myocardial and cerebral injury after major cardiovascular and neurovascular surgery. Remote ischemic preconditioning is a safe, effective, noninvasive, and cost-effective strategy for reducing ischemia-reperfusion injury in clinical settings. This study was designed to investigate whether limb remote ischemic preconditioning is beneficial to surgical outcome in patients undergoing craniotomy for supratentorial meningioma and to provide scientific basis for its clinical application in the future.ObjectiveTo investigate the effect of remote ischemic preconditioning on cerebral ischemia-reperfusion injuryin patients undergoing craniotomy for supratentorial meningioma Methods66 adult meningiomas patients undergoing elective craniotomy for supratentorial meningioma were randomly assigned to either a remote ischemic preconditioning group (n=26) or a control group (n=30) before induction of anesthesia. Limb remote ischemic preconditioning consisted of three 5-min cycles of right upper limb ischemia, induced by an automated cuff-inflator placed on the upper arm and inflated to 200 mmHg, with an intervening 5 min of reperfusion during which the cuff was deflated. Blood samples were taken before the induction of anesthesia (PreA), before RIPC (PreR), before cranial dura opening (PreO), 4h, 24h, 3d, and 7d after cranial dura opening (PostO). CSF samples were taken at before RIPC (PreR), before cranial dura opening (PreO), 4h, and 24h after cranial dura opening (PostO). Serum and CSF concentrations of S-100B and NSE were assayed by use of commercially available sandwich technique enzyme-linked immunosorbent assay (ELISA) kits (BioVendor, Czech republi,forS-100B;ADI,USA,forNSE).Amini-mental-state examination (MMSE) were conducted preoperatively and 48 hours and 7 days after surgery. Glasgow Coma Scale was recorded at preoperative, 2 days, and 7days after surgery.Results1.Biochemical markersRemote ischemic preconditioning significantly reduced serum NSE release at 4 h, 24 h after after opening of the dura ,and CSF S-100B and NSE release at 4 h, 24 h after opening of the dura (P<0.05). 2. Neurological function evaluation:The preoperative MMSE scores are similar in two groups. The MMSE scores in the RIPC group are higher that that in the Control group at 2 days and 7days after surgery (P>0.05).ConclusionsThe present study demonstrates that adult meningiomas patients undergoing elective craniotomy for supratentorial meningioma at a single center could benefit from remote ischemic preconditioning, using transient upper limb ischemia. These novel data support the need for a larger multi-center clinical study of RIPC in patients undergoing elective craniotomy for supratentorial meningioma...
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