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Continuous intraoperative EEG monitoring during carotid surgery
Insights
Continuous electroencephalography (EEG) monitoring during carotid revascularization provides valuable insights into cerebral function. Stump pressure measurements alone are insufficient for detecting cerebral ischemia.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Carotid revascularization procedures carry risks of cerebral ischemia.
- Intraoperative monitoring is crucial for patient safety during carotid surgery.
- Electroencephalography (EEG) and stump pressure are potential monitoring tools.
Purpose of the Study:
- To evaluate the utility of continuous intraoperative EEG monitoring and stump pressure measurements in carotid revascularization.
- To determine the correlation between EEG changes and stump pressure values.
- To assess the impact of EEG-guided shunting on patient outcomes.
Main Methods:
- Continuous intraoperative EEG monitoring and stump pressure measurements were performed during 85 carotid revascularizations.
- The decision to insert a temporary shunt was based on EEG abnormalities.
- Patients included symptomatic cerebrovascular individuals and asymptomatic subjects with cervical bruit.
Main Results:
- Intraoperative EEG abnormalities indicated the need for shunting in 11 patients with contralateral carotid lesions, with EEG normalizing post-shunting.
- Stump pressure values exhibited significant variability and poor correlation with EEG changes.
- No perioperative deaths or new neurological deficits were observed; one case of asymptomatic carotid rethrombosis occurred during follow-up.
Conclusions:
- Continuous intraoperative EEG monitoring offers valuable information on cerebral function during carotid revascularization.
- EEG monitoring can help reduce intraoperative complications.
- Stump pressure measurement alone is not a reliable indicator of cerebral ischemia during carotid cross-clamping.
Abstract:
Continuous intraoperative EEG monitoring and stump pressure measurements were studied during 85 carotid revascularizations performed in 40 symptomatic cerebrovascular patients and in 32 asymptomatic subjects with a cervical bruit. The decision to place a temporary shunt was made on the basis of intraoperative EEG abnormalities regardless of stump pressure values. 11 patients with contralateral carotid lesions showed marked EEG alterations, at the moment of clamping, which returned to normal after the placement of an indwelling shunt. Stump pressure values showed a wide variation and a poor correlation with intraoperative EEG changes. In the early postoperative period there were no deaths; no new neurological deficits were detected. In the follow-up there was only 1 asymptomatic carotid rethrombosis, not revealed by the EEG, which was suspected by Doppler sonography and confirmed by angiography. The authors conclude that EEG gives valuable information about cerebral functions during carotid revascularization and can reduce the intraoperative complications of the procedure. Stump pressure measurement cannot be used alone as a safe indicator of cerebral ischemia during carotid cross-clamping.