Research Projects

The brain tumour microenvironment contains many non-cancerous cell types in addition to cancer cells, including endothelial cells, pericytes, fibroblasts and immune cells. Injury to this peritumoral zone during the surgery sets off an inflammatory cascade. This results in neuroinflammation, which damages the integrity of the blood-brain barrier(BBB), leading to cerebral oedema, impairment of cerebral autoregulation, and microthrombi formation, all of which could result in poor patient outcomes. Moreover, neuroinflammation is a key contributor to the etiopathogenesis of perioperative cognitive disorders(PCD), which is frequently encountered in patients undergoing major surgery. It has a varied presentation from short-term disturbances such as postoperative delirium and delayed neurocognitive recovery to long-term disturbances such as postoperative neuro-cognitive disorder are often overlooked or misdiagnosed. PCD is shown to have a synergistic relationship with neurodegenerative diseases, thereby making their impact even more concerning. Patients undergoing neurosurgery for the excision of brain tumours are at a higher risk of neuroinflammation and PCD than non-neurosurgeries due to BBB disruption and direct brain handling. The often overlooked factor which significantly contributes to the patient outcome is the effects of anaesthetic agents on perioperative neuroinflammation. Recent studies have shown that central nervous system inflammation provoked by surgery and certain anaesthetic agents play an important role in the patient outcome, especially concerning PCD. Anaesthesia and surgery have been shown to increase the brain concentration of interleukin (IL)-6, leading to neuronal apoptosis. In addition, anaesthetic agents such as propofol and local anaesthetic agents affect the immune system by decreasing the levels of pro-inflammatory cytokines. Neurosurgical scenarios will provide an ideal opportunity to study the effect of anaesthetic agents on neuroinflammation and its association with patient outcomes and PCD in patients with intracranial pathologies. Novelty: Propofol-based total intravenous anaesthesia (TIVA) and Sevoflurane-based inhalational anaesthesia (INHA) are the two standards of care anaesthetic practice in neurosurgical settings. However, there is a lacuna in the research pertaining to the impact of TIVA and INHA on neuroinflammatory markers in the neurosurgery population and its effect on patient outcomes and PCD. No previous randomized controlled trials compared the effect of anaesthetic agents on neuroinflammation in neurosurgical settings, especially regarding the patient outcome and PCD. However, it is essential to ascertain the difference in the perioperative neuroinflammation between the two anaesthetic techniques and their association with patient outcomes and PCD. The results of this study can be used to identify the ideal anaesthetic regimen for patients undergoing neurosurgery in terms of better patient outcomes.