Computerized topographic brain mapping during carotid endarterectomy.
Computerized topographic brain mapping processes standard electroencephalographic data and displays it in a color map, thus simplifying interpretation. During a 2-year period, 65 carotid endarterectomies were performed with the use of brain mapping as the sole criterion for shunt replacement. Forty-three patients (66%) were found to have abnormal brain maps preoperatively. Ten patients (15%) developed ischemic changes after cross-clamping (all resolved after shunt placement). Postoperative brain maps were unchanged in 54 patients (83%) and improved in 7 patients (11%). A new, small focal abnormality was identified in 4 patients without shunts (6%), none of whom had a change in neurologic status. The overall major morbidity and mortality was 1.5%. Computerized brain mapping is a sensitive and readily interpretable means of monitoring cerebral perfusion during carotid surgery. We found the computerized electroencephalographic data to be a dependable criterion for selective shunting and for confirmation of shunt patency during carotid endarterectomy.
Elmore
J R
JR
Department of Surgery, Maine Medical Center, Portland 04102.
Eldrup-Jorgensen
J
J
Leschey
W H
WH
Herbert
W E
WE
Dillihunt
R C
RC
Ray
F S
FS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply; D001931:Brain Mapping / Q000379:methods*; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D003936:Diagnosis, Computer-Assisted; D004569:Electroencephalography; D004691:Endarterectomy; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies