Acta Neurochir (2003) 145: 667–671 DOI 10.1007/s00701-003-0083-5 Clinical Article C-reactive protein levels following standard neurosurgical procedures J. Bengzon 1 , A. Grubb 2 , A. Bune 1 , K. Hellstro ¨m 1 , V. Lindstro ¨m 2 , and L. Brandt 1 1 Department of Neurosurgery, University Hospital, Lund, Sweden 2 Department of Clinical Chemistry, University Hospital, Lund, Sweden Published online July 23, 2003 # Springer-Verlag 2003 Summary Background. The aim of the present study was to establish the mag- nitude and time-course of C-reactive protein increases following routine neurosurgical procedures in the absence of clinical and laboratory signs of infection. Method. C-reactive protein levels were studied daily following ven- triculo-peritoneal shunt implantation, anterior cervical fusion, vestibular schwannoma operation, supratentorial glioma surgery, endovascular intracranial aneurysm treatment and open cerebral aneurysm surgery. Findings. The magnitude of the C-reactive protein increase depended on the extent of surgical trauma and peak-levels were recorded between postoperative day one and four after which the levels tapered off. Interpretation. Increases occurring after the fourth postoperative day are likely to be caused by complications of surgery, e.g. infection. Keywords: C-reactive protein; postoperative; neurosurgery. Introduction C-reactive protein (CRP) is an acute-phase protein synthesized and rapidly secreted by the liver in response to inflammation, infection and malignancy [3, 21]. Repeated determinations of CRP levels in serum have been extensively used as a simple and reliable method for the early detection of a bacterial infection and for the subsequent monitoring of the response to treatment [6, 13, 17]. C-reactive protein levels markedly increase within the first 6 hours following the onset of a bacterial infection and the increase subsides rapidly after treat- ment of the infection [7–9]. The usefulness of CRP monitoring for detection of postoperative infections is, however, limited by the fact that the surgical trauma per se lead to an inflammatory response and a subse- quent increase in serum CRP levels [10, 16]. Determina- tion of the serum CRP response to uncomplicated surgery is therefore required in order to be able to use CRP measurements in the diagnosis of postoperative infection. Although CRP levels have been studied pre- viously following various kinds of surgical procedures in the absence and presence of postoperative infection, no study has specifically addressed the CRP response to neurological surgery (e.g. [2, 4, 15, 20]). The objective of the present study was therefore to determine the magnitude and time-course of serum CRP increases following neurosurgical procedures uncompli- cated by postoperative infection. Patients and methods Patient selection Written consent to participation in the study was obtained from each patient before blood samples were taken. A normal ( <5 mg=l) preoper- ative CRP level was a prerequisite for inclusion. Body temperature was measured daily one day prior to surgery and daily postoperatively. Patients with a body temperature >38 centigrades and patients with any sign of an infectious complication were excluded. General anesthesia was used in every patient. Factors of potential influence on the CRP level such as the type of anesthesia, amount of bleeding, blood transfusion, operation time and the use of antibiotics and anti-inflammatory drugs were recorded. The different types of operations were chosen to represent common standard neurosurgical trauma of various severity. Four patients (aged 50 Æ 14 years, range 33–79 years) underwent standard ventriculo-peritoneal shunt implantation because of normal pressure hydrocephalus using the Codman Medos (Johnson and Johnson, Raynham, MA) shunt system. The anterior cervical fusion group comprised six patients (aged 54 Æ 8 years, range 37–84 years) operated on at a single level with implantation of a carbon cage. The vestibular schwannoma group consisted of eight patients (aged 58 Æ 3 years, range 48–71 years) operated on either by a suboccipital or translabyrinthine approach. Seventeen patients (aged 61 Æ 3 years, range 41–80 years) were included in the supratentorial glioma group. Gliomas of all histopathological grades were represented.