scholarly journals Limitations of median nerve somatosensory evoked potential monitoring during carotid endarterectomy

2019 ◽  
Vol 131 (3) ◽  
pp. 750-756 ◽  
Author(s):  
Sumito Okuyama ◽  
Shinjitsu Nishimura ◽  
Yoshiharu Takahashi ◽  
Keiichi Kubota ◽  
Takayuki Hirano ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cerebral Ischemia ◽  
Carotid Endarterectomy ◽  
Median Nerve ◽  
Cerebral Artery ◽  
Evoked Potential ◽  
Anterior Cerebral Artery ◽  
Linear Regression Analysis ◽  
Somatosensory Evoked Potential ◽  
Stump Pressure

OBJECTIVEHypoperfusion during carotid artery cross-clamping (CC) for carotid endarterectomy (CEA) may result in the major complication of perioperative stroke. Median nerve somatosensory evoked potential (MNSSEP) monitoring, which is an established method for the prediction of cerebral ischemia, has low sensitivity in detecting such hypoperfusion. In this study the authors sought to explore the limitations of MNSSEP monitoring compared to tibial nerve somatosensory evoked potential (TNSSEP) monitoring for the detection of CC-related hypoperfusion.METHODSThe authors retrospectively analyzed data from patients who underwent unilateral CEA with routine shunt use. All patients underwent preoperative magnetic resonance angiography and were monitored for intraoperative cerebral ischemia by using MNSSEP, TNSSEP, and carotid stump pressure during CC. First, the frequency of MNSSEP and TNSSEP changes during CC were analyzed. Subsequently, variables related to stump pressure were determined by using linear analysis and those related to each of the somatosensory evoked potential (SSEP) changes were determined by using logistic regression analysis.RESULTSA total of 94 patients (mean age 74 years) were included in the study. TNSSEP identified a greater number of SSEP changes during CC than MNSSEP (20.2% vs 11.7%; p < 0.05). Linear regression analysis demonstrated that hypoplasia of the contralateral proximal segment of the anterior cerebral artery (A1 hypoplasia) (p < 0.01) and hypoplasia of the ipsilateral precommunicating segment of the posterior cerebral artery (P1 hypoplasia) (p = 0.02) independently and negatively correlated with stump pressure. Both contralateral A1 hypoplasia (OR 26.25, 95% CI 4.52–152.51) and ipsilateral P1 hypoplasia (OR 8.75, 95% CI 1.83–41.94) were independently related to the TNSSEP changes. However, only ipsilateral P1 hypoplasia (OR 8.76, 95% CI 1.61–47.67) was independently related to MNSSEP changes.CONCLUSIONSTNSSEP monitoring appears to be superior to MNSSEP in detecting CC-related hypoperfusion. Correlation with stump pressure and SSEP changes indicates that TNSSEP, and not MNSSEP monitoring, is a reliable indicator of cerebral ischemia in the territory of the anterior cerebral artery.

scholarly journals The effect of acetazolamide on electroencephalogram and somatosensory evoked potential in patients with major cerebral artery occlusion.

Nosotchu ◽  
1989 ◽  
Vol 11 (5) ◽  
pp. 592-599 ◽  
Author(s):  
Yasuhiro Hasegawa ◽  
Takenori Yamaguchi ◽  
Takashi Tsuchiya ◽  
Hideki Moriyasu ◽  
Tsunehiko Nishimura
Keyword(s):  
Cerebral Artery ◽  
Evoked Potential ◽  
Artery Occlusion ◽  
Somatosensory Evoked Potential ◽  
Cerebral Artery Occlusion

Somatosensory Evoked Potential and Transcranial Doppler Monitoring to Guide Shunting in Carotid Endarterectomy

2020 ◽  
Author(s):  
Kathleen Seidel ◽  
Johannes Jeschko ◽  
Philippe Schucht ◽  
David Bervini ◽  
Christian Fung ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Death Rate ◽  
Evoked Potential ◽  
Somatosensory Evoked Potential ◽  
End Point ◽  
Neurologic Deficits ◽  
Ica Stenosis ◽  
Sep Monitoring

Abstract Objective Clamping of the internal carotid artery (ICA) during carotid endarterectomy (CEA) is a critical step. In our neurosurgical department, CEAs are performed with transcranial Doppler (TCD) and somatosensory evoked potential (SEP) monitoring with a 50% flow velocity/amplitude decrement warning criteria for shunting. The aim of our study was to evaluate our protocol with immediate neurologic deficits after surgery for the primary end point. Methods This is a single-center retrospective cohort study of symptomatic and asymptomatic ICA stenosis patients from January 2012 to June 2015. Only those cases in which CEA was performed with both modalities (TCD and SEP) were included. The Mann-Whitney U test was applied to evaluate TCD and SEP ratios based on immediate postoperative neurologic deficits. Results A total of 144 patients were included, 120 (83.3%) with symptomatic ICA stenosis. The primary end point was met by six patients (4.2%); all of them were patients with a symptomatic ICA stenosis. The stroke and death rate was 1.4%. Ratios of SEP amplitudes demonstrated significant differences between patients with and without an immediate postoperative neurologic deficit at the time of ICA clamping (p = 0.005), ICA clamping at 10 minutes (p = 0.044), and ICA reperfusion (p = 0.005). Ratios of TCD flow velocity showed no significant difference at all critical steps. Conclusion In this retrospective series of simultaneous TCD and SEP monitoring during CEA surgery of predominantly symptomatic ICA stenosis patients, the stroke and death rate was 1.4%. SEP seemed to be superior to TCD in predicting the need for an intraoperative shunt and for predicting temporary postoperative deficits. Further prospective studies are needed.

scholarly journals Intraoperative middle cerebral artery pressure measurements during superficial temporal artery to middle cerebral artery bypass procedures in patients with cerebral atherosclerotic disease

2016 ◽  
Vol 125 (6) ◽  
pp. 1367-1373 ◽  
Author(s):  
Fumihiro Matano ◽  
Yasuo Murai ◽  
Rokuya Tanikawa ◽  
Hiroyasu Kamiyama ◽  
Kojiro Tateyama ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Linear Regression Analysis ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Atherosclerotic Disease ◽  
Normal Side ◽  
Rate Of Increase

OBJECTIVE No previous study has monitored middle cerebral artery (MCA) pressure during the superficial temporal artery (STA)-MCA bypass procedure for cerebral atherosclerotic disease. In this paper, the authors describe their method of monitoring MCA pressure and report their initial data on intraoperative MCA pressure and its relationship with hemodynamics prior to and after the bypass procedures. METHODS The results from a total of 39 revascularization procedures performed between 2004 and 2014 were analyzed. The patient group included 27 men and 12 women, and their mean age at surgery was 67.6 years (range 39–83 years). The authors investigated the MCA pressure via the STA during STA-MCA bypass procedures. After one branch of the STA was anastomosed to the MCA, the other branch was connected to an arterial line, and a clip was placed temporally on the main STA trunk to monitor the pre-anastomosis MCA pressure. Simultaneously, the radial artery (RA) pressure was determined before removing the temporal clip to measure the post-anastomosis MCA pressure. The relationship between MCA pressures and single photon emission computed tomography findings and the risk factors for hyperperfusion after STA-MCA bypass were analyzed. RESULTS The MCA/RA (%) pressure was significantly correlated with that of the resting stenotic/normal side cerebral blood flow (CBF) ratio (%) in the linear regression analysis (slope 1.200, r2 = 0.3564, F = 20.49, p < 0.0001). The intraoperative MCA pressure was 39.3% of RA pressure in patients with Powers' Stage 2 cerebral atherosclerotic disease. After 1 branch of the STA was anastomosed, the intraoperative MCA pressure increased to 75.3% of the RA pressure. The rate of increase in pressure was significantly correlated with the increase in the STA diameter in the linear regression analysis (slope 2.59, r2 = 0.205, F = 9.549, p = 0.0038). Hyperperfusion occurred in 2 cases. When mean values for these 2 patients were compared with those for the 37 patients without hyperperfusion, significant differences were found in the stenotic/normal side CBF ratio (p = 0.0001), pre-anastomosis MCA pressure (p = 0.02), rate of increase in pressure (p = 0.02), pre-anastomotic MCA/RA pressure ratio (p = 0.01), vascular reserve (p = 0.0489), and STA diameter (p = 0.0002). CONCLUSIONS The measurement of intraoperative MCA pressure may be a useful technique to assess cerebral perfusion and for predicting the risk of hyperperfusion. Monitoring MCA pressure is recommended during STA-MCA bypass procedures for atherosclerotic disease.

Sign in / Sign up

Export Citation Format

Share Document