Muscle weakness in the early postoperative period after removal of a brain tumor

   Summary. The weakness of skeletal muscles arising in patients receiving intensive therapy is attracting more and more attention of doctors of various specialties. Clinical and electrophysiological symptoms of critical illness polyneuropathy (PNMPCS) are insufficiently systematized. Despite conciliatory protocols, diagnostic criteria remain highly subjective. The reasons for the development, the symptoms of this variant of muscle weakness, are not sufficiently systematized. There are many questions about the relationship between paresis and paralysis due to focal lesions of the central nervous system (CNS) and PNMPCS, especially after removal of brain tumors.

   Purpose of the study: to study the effect of intraoperative fluctuations in systemic hemodynamic parameters on the function of striated muscles in patients with brain tumors.

   Materials and methods: To solve this problem, 49 cases were studied, divided into two groups, taking into account the instability of hemodynamics: parasagittal meningiomas – 15, basal meningiomas – 15, vestibular schwannomas – 19. The dynamics of neurological symptoms after surgery, taking into account the characteristics of anesthesia, instability systemic hemodynamics, intraoperative blood loss.

   Results. In patients of the first group, paralysis and paresis of skeletal muscles were symptoms of focal brain damage due to the effect of a tumor or vascular pathology. In the absence of complications after tumor removal, focal neurological symptoms regressed on the first day after the end of the operation. General muscle weakness in these patients was associated with the action of drugs used for anesthesia. One of the main criteria for the sufficiency of muscle strength, traditional in anesthesiology and resuscitation, is the possibility of spontaneous breathing. We considered prolonged muscle weakness in comparison with the first group in patients of the second group as a result of muscle hypo-reperfusion against the background of instability of the systemic circulation. An increase in the level of myoglobin in the blood indicates a violation of the permeability of the membranes of myocytes. Apparently, muscle weakness is a natural clinical manifestation of this condition.

   Conclusion. “Non-neuronal” factors and, in particular, disorders of systemic hemodynamics, play a significant role in the development of weakness of the striated muscles in the reoperative period in patients with brain tumors. Potentially, dysfunction of skeletal muscles may be accompanied by metabolic disorders associated, apparently, with increased permeability of muscle cell membranes under hypoperfusion-reperfusion conditions.

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