Experience of 500 cases of neurophysiological monitoring in carotid endarterectomy

Stejskal, L; Kramář, Filip; Ostrý, Svatopluk; Beneš, Vladimı́r; Mohapl, M; Limberk, B.

doi:10.1007/s00701-007-1228-8

Cited by 25 publications

(21 citation statements)

References 39 publications

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“…In particular, we are concerned with potential injury which may be prevented due to regional parenchymal compression secondary to port manipulation and hemispheric changes in blood flow related to the procedure. The use of intraoperative SSEP monitoring has been shown to be effective in predicting post operative deficits under a number of circumstances including spine,3-6 carotid endarterectomies,10,13 skull based,1,2 and more recently minimally invasive skull based surgeries 21. This form of intraoperative monitoring can predict and prevent post operative morbidity by alerting the surgeon to intraoperative changes which may compromise the somatosensory pathway.…”

Section: Discussionmentioning

confidence: 99%

“…Reversible and irreversible changes1,10,21,25 in SSEP waveforms significantly increase the likelihood of post operative deficits and allow for possible intraoperative adjustments to prevent post operative complications. Animal models indicate that a drop in CBF below 16 to 20 mL/100g/minute causes a reversible decrease in the amplitude of cortical SSEP responses 26,27.…”

Section: Discussionmentioning

confidence: 99%

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Predictive Value of Somatosensory Evoked Potential Monitoring during Resection of Intraparenchymal and Intraventricular Tumors Using an Endoscopic Port

et al. 2013

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Background and PurposeIntraoperative neurophysiological monitoring (IONM) using upper and lower somatosensory evoked potentials (SSEPs) is an established technique used to predict and prevent neurologic injury during intracranial tumor resections. Endoscopic port surgery (EPS) is a minimally-invasive approach to deep intraparenchymal and intraventricular brain tumors. The authors intended to evaluate the predictive value of SSEP monitoring during resection of intracranial brain tumors using a parallel endoscopic technique.MethodsA retrospective review was conducted of patients operated on from 2007-2010 utilizing IONM in whom endoscopic ports were used to remove either intraparenchymal or intraventricular tumors. Cases were eligible for review if an endoscopic port was used to resect an intracranial tumor and the electronic chart included all intraoperative monitoring data as well as pre- and post-operative neurologic exams.Results139 EPS cases met criteria for inclusion. Eighty five patients (61%) had intraparenchymal and fifty four (39%) had intraventricular tumors or colloid cysts. SSEP changes were seen in eleven cases (7.9%), being irreversible in three (2.2%) and reversible in eight cases (5.8%). Seven patients (5.0%) with intraparenchymal tumors had SSEP changes which met our criterea for significant changes while there were four (2.9%) with intraventricular (p-value=0.25). Five patients suffered post operative deficits, two reversible and two irreversible SSEP changes. Only one case exhibited post operative hemiparesis with no SSEP changes. The positive predictive value of SSEP was 45.4% and the negative predictive value was 99.2%.ConclusionsBased on the high negative and low positive predictive values, the utility of SSEP monitoring for cylindrical port resections may be limited. However, the use of SSEP monitoring can be helpful in reducing the impact of endoscopic port manipulation when the tumor is closer to the somatosensory pathway.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictive Value of Somatosensory Evoked Potential Monitoring during Resection of Intraparenchymal and Intraventricular Tumors Using an Endoscopic Port

et al. 2013

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“…EEG can provide continuous information on neuronal function and may help identify situations that require more aggressive elevation of CPP. The relationship between EEG changes and cerebral blood flow has been demonstrated previously, and there is extensive literature on the use of EEG for intra-operative monitoring, for example, during carotid endarterectomy [20][21][22][23][24][25][26][27][28]. Previous studies have clearly documented a relationship between cerebral blood flow and EEG changes [21,25,29].…”

Section: Discussionmentioning

confidence: 78%

“…Suppression of all the frequencies was associated with neuronal cell death and a CBF below 10 ml/100 mg/min (for review see [30]). While some studies report good reliability of EEG monitoring [21,23,27,28], others failed to detect consistently cerebral ischemia [20,22,26,31]. The same holds true for quantitative and higher-order measures of EEG analysis [32][33][34][35].…”

Section: Discussionmentioning

confidence: 97%

Quantitative EEG Correlates of Low Cerebral Perfusion in Severe Stroke

et al. 2009

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“…Various methods have been practiced to monitor brain perfusion throughout the surgery, determining when shunting of the artery is necessary (selective shunting). These methods vary in cost and effectiveness, but the most controversial in the literature is electrophysiological monitoring (EM) with some reports suggesting that it is the most effective means of monitoring[5]–[8] and others suggesting that it is ineffective[9],[10]. This report attempts to resolve the issue with multiple surgeons, multiple neurophysiologists, and multiple sites, but a common training program.…”

Section: Introductionmentioning

confidence: 99%

Protocol for electrophysiological monitoring of carotid endarterectomies

Giorgio

Williams

et al. 2010

Journal of Biomedical Research

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Near zero stroke rates can be achieved in carotid endarterectomy (CEA) surgery with selective shunting and electrophysiological neuromonitoring. though false negative rates as high as 40% have been reported. We sought to determine if improved training for interpretation of the monitoring signals can advance the efficacy of selective shunting with electrophysiological monitoring across multiple centers, and determine if other factors could contribute to the differences in reports. Processed and raw beta band (12.5-30 Hz) electroencephalogram (EEG) and median and tibial nerve somatosensory evoked potentials (SSEP) were monitored in 668 CEA cases at six surgical centers. A decrease in amplitude of 50% or more in any EEG or SSEP channel was the criteria for shunting or initiating a neuroprotective protocol. A reduction of 50% or greater in the beta band of the EEG or amplitude of the SSEP was observed in 150 cases. No patient showed signs of a cerebral infarct after surgery. Selective shunting based on EEG and SSEP monitoring can reduce CEA intraoperative stroke rate to a near zero level if trained personnel adopted standardized protocols. We also found that the rapid administration of a protective stroke protocol by attending anesthesiologists was an important aspect of this success rate.

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Experience of 500 cases of neurophysiological monitoring in carotid endarterectomy

Abstract: A decrease of more than 50% in the amplitude of the thalamocortical somatosensory evoked potential complex N20/P25 proved to be the most reliable warning of danger of ischaemia during carotid endarterectomy.

Cited by 25 publications

References 39 publications

Predictive Value of Somatosensory Evoked Potential Monitoring during Resection of Intraparenchymal and Intraventricular Tumors Using an Endoscopic Port

Predictive Value of Somatosensory Evoked Potential Monitoring during Resection of Intraparenchymal and Intraventricular Tumors Using an Endoscopic Port

Quantitative EEG Correlates of Low Cerebral Perfusion in Severe Stroke

Protocol for electrophysiological monitoring of carotid endarterectomies

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