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Computerized topographic brain mapping during carotid endarterectomy.

J R Elmore1, J Eldrup-Jorgensen, W H Leschey

  • 1Department of Surgery, Maine Medical Center, Portland 04102.

Archives of Surgery (Chicago, Ill. : 1960)
|June 1, 1990
PubMed
Summary

Computerized topographic brain mapping (CTBM) effectively monitors brain perfusion during carotid endarterectomy. This electroencephalographic tool aids in shunt decisions and confirms shunt patency, ensuring patient safety.

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Neurology

Background:

  • Carotid endarterectomy requires monitoring cerebral perfusion to prevent ischemia.
  • Interpreting electroencephalographic (EEG) data can be complex.
  • Objective criteria for shunt management are crucial during carotid surgery.

Purpose of the Study:

  • To evaluate the utility of computerized topographic brain mapping (CTBM) in monitoring cerebral perfusion during carotid endarterectomy.
  • To assess CTBM's role as a criterion for selective shunt replacement.
  • To determine the effectiveness of CTBM in confirming shunt patency.

Main Methods:

  • A 2-year retrospective study involving 65 carotid endarterectomies.
  • Computerized topographic brain mapping (CTBM) using standard electroencephalographic (EEG) data.

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  • CTBM was the sole criterion for shunt replacement decisions.

    • Main Results:

    • 66% of patients had abnormal preoperative brain maps.
    • 15% developed intraoperative ischemic changes, all resolving with shunting.
    • Postoperative maps were unchanged in 83% and improved in 11%; 6% showed new focal abnormalities without neurological change.
    • Major morbidity and mortality were 1.5%.

    Conclusions:

    • Computerized topographic brain mapping (CTBM) provides a sensitive and interpretable method for monitoring cerebral perfusion.
    • CTBM is a dependable criterion for selective shunting during carotid endarterectomy.
    • CTBM effectively confirms shunt patency, contributing to improved surgical outcomes.