Postoperative Delirium in Neurosurgical Patients: Recent Insights into the Pathogenesis

Abstract

Postoperative delirium (POD) is a complication characterized by disturbances in attention, awareness, and cognitive function that occur shortly after surgery or emergence from anesthesia. Since it occurs prevalently in neurosurgical patients and poses great threats to the well-being of patients, much emphasis is placed on POD in neurosurgical units. However, there are intricate theories about its pathogenesis and limited pharmacological interventions for POD. In this study, we review the recent insights into its pathogenesis, mainly based on studies within five years, and the five dominant pathological theories that account for the development of POD, with the intention of furthering our understanding and boosting its clinical management.

Keywords: cognitive dysfunction; neurosurgery; postoperative delirium.

Figure 1

Schematic diagram of pathological mechanisms underlying postoperative delirium: (A) five dominant pathological theories that may account for the occurrence and development of POD characterized by disturbances in attention, awareness, and cognition; (B) S100A8, as a main member of DAMPs, promotes the activation of TLR4 in macrophages and microglia and then increases the expression of TNF-α; TNF-α will bind to TNFR on endothelial cells, subsequently triggering their necroptosis, which disrupts BBB’s integrity and increases BBB’s permeability.