Lipid Peroxidation and Antioxidant Consumption as Early Markers of Neurosurgery-Related Brain Injury in Children


Background and Aims

Lipid peroxidation represents a marker of secondary brain injury both in traumatic and in non-traumatic conditions—as in major neurosurgical procedures—eventually leading to brain edema amplification and further brain damage. Malondialdehyde (MDA), a lipid peroxidation marker, and ascorbate, a marker of antioxidant status, can represent early indicators of this process within the cerebrospinal fluid (CSF). We hypothesized that changes in cerebral lipid peroxidation can be measured ex vivo following neurosurgery in children.


Thirty-six children (M:F = 19/17, median age 32.9 months; IQR 17.6–74.6) undergoing neurosurgery for brain tumor removal were admitted to the pediatric intensive care unit (PICU) in the postoperative period with an indwelling intraventricular catheter for intracranial pressure monitoring and CSF drainage. Plasma and CSF samples were obtained for serial measurement of MDA, ascorbate, and cytokines.


An early brain-limited increase in lipid peroxidation was measured, with a significant increase from baseline of MDA in CSF (p = 0.007) but not in plasma. In parallel, ascorbate in CSF decreased (p = 0.05). Systemic inflammatory response following brain surgery was evidenced by plasma IL-6/IL-8 increase (p 0.0022 and 0.0106, respectively). No correlation was found between oxidative response and tumor site or histology (according to World Health Organization grading). Similarly, lipid peroxidation was unrelated to the length of surgery (mean 321 ± 73 min), or intraoperative blood loss (mean 20.9 ± 16.8% of preoperative volemia, 44% given hemotransfusions). Median PICU stay was 3.5 days (IQL range 2–5.5 d.), and postoperative ventilation need was 24 h (IQL range 20–61.5 h). The elevation in postoperative MDA in CSF compared with preoperative values correlated significantly with postoperative ventilation need (P = 0.05, r2 0168), while no difference in PICU stay was recorded.


Our results indicate that lipid peroxidation increases consistently following brain surgery, and it is accompanied by a decrease in antioxidant defences; intraventricular catheterization offers a unique chance of oxidative process monitoring. Further studies are needed to evaluate whether monitoring post-neurosurgical oxidative stress in CSF is of prognostic utility.

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Author information




Marco Piastra MD (M.P.), Elena Caresta MD (E.C.), Giorgio Conti MD (G.C.), and Simon Eaton MD (S.E.) designed the study, analyzed the data, and wrote the first draft of the paper; designed the study and wrote the first draft of the paper; Luca Massimi MD (L.M.), Enzo Picconi MD (E.P.), and Ersilia Luca MD (E.L.) recruited the patients and collected the data; Tony Christian Morena MD (T.C.M.) is the corresponding author, and also recruited the patients and collected the data.

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Correspondence to T. C. Morena.

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The study was approved by the Institutional Review Board of the Universita Cattolica del Sacro Cuore. Participation in the survey implies informed consent from the participants.

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Piastra, M., Caresta, E., Massimi, L. et al. Lipid Peroxidation and Antioxidant Consumption as Early Markers of Neurosurgery-Related Brain Injury in Children. Neurocrit Care 33, 124–131 (2020).

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  • Pediatric neurosurgery
  • Pediatric intensive care
  • Antioxidant activity
  • Lipid peroxidation
  • Brain injury