Peri-operative changes of cellular and humoral components of immunity with brain tumour surgery

Abstract

Nosocomial infections, which are not uncommon in neurosurgical intensive care medicine, may possibly be favoured by an impairment of immunological competence of the patient. In a prospective observational trial, we investigated several parameters of cellular and humoral immunity in 32 patients before and after resection of an intracranial tumour. We quantified the effects of operative procedure, dexamethasone pretreatment, and tumour type. Dexamethasone alone causes an increase of neutrophilic granulocyte count and monocytes, whereas IgG and eosinophilic granulocytes decrease as well as lymphocytes. CD4+ T lymphocytes (T helper cells) and CD8+ T lymphocytes (T cytotoxic/suppressor cells) were more severely affected than B lymphocytes. Dexamethasone and operation in combination act synergistically on T lymphocytes and IgG, while no synergism is obvious in other clinical test parameters. The skin sensitivity reaction was depressed accordingly. With intracerebral tumours (gliomas WHO grades II to IV), levels of T helper cells and eosinophilic granulocytes were lower, and levels of IgM and neutrophilic granulocytes were higher than with benign extracerebral neoplasms. Postoperative nosocomial infections of the lower respiratory tract occurred almost exclusively in patients subject to severe depression of T helper cells.

Intracranial malignant lesions correlate with the requirement for a long treatment course in postoperative central nervous system infection

“…In addition, lymphocyte activity was significantly lower after surgery compared with the preoperative period, despite a notably increased count 28. T-helper cell and eosinophil levels were found to be lower in patients with intracranial malignant tumors (World Health Organization grade II–IV glioma) than in those with benign lesions, while immunoglobulin (Ig) M and neutrophil levels were higher 29. Previous studies have also reported that postoperative serum IgA and IgG levels were significantly reduced in patients with intracranial malignant tumors 30.…”

Leukocytosis after routine cranial surgery: A potential marker for brain damage in intracranial surgery

“…Gliomas are known to produce immunodepression by releasing anti-inflammatory cytokines like IL-10, and soluble factors which have been reported earlier. [ 10 ] There were decreased levels of eosinophilic granules and T-helper cells, but higher levels of IgM in the glioma patients, compared to other neoplasms, thus depressing the cellular immunity. In our study, fair variability of tumors [ Table 4 ] has eliminated this likely bias.…”