title: Electroencephalogram monitoring during intracranial surgery for moyamoya disease.
abstract: We describe our experience with intraoperative electroencephalography in moyamoya surgery, a method to monitor for ischemic changes during the procedure and to minimize the risk of intraoperative and perioperative stroke. Case records and intraoperative electroencephalography recordings of all patients (n=220) treated with surgical revascularization for moyamoya (pial synangiosis) performed for 14 years (1994-2008) were reviewed. Electroencephalographic slowing occurred in 100 cases (45.5%), and was persistent in nine cases (9%). Slowing coincided with specific operative manipulations, most commonly while suturing the donor vessel to the pia, and during closure of the craniotomy. Slowing generally occurred bilaterally, independently of the side of intervention. The presence, length, and severity of slowing were not predictive of perioperative ischemic events. We present additional data on intraoperative electroencephalography with a modified montage to accommodate the craniotomy. Although not predictive of perioperative ischemic events in this series, electroencephalographic changes were correlated with specific operative interventions, and revealed global responses to unilateral manipulation. These findings suggest that prospective analyses of this technique may elucidate additional methods of predicting (and possibly preventing) perioperative ischemic events.
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology and Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Martina
authors.initials: M
authors.lastname: Vendrame
authors.forename: Joseph
authors.initials: J
authors.lastname: Kaleyias
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.forename: Ed
authors.initials: E
authors.lastname: Smith
authors.forename: Craig
authors.initials: C
authors.lastname: McClain
authors.forename: Mark
authors.initials: M
authors.lastname: Rockoff
authors.forename: Sheryl
authors.initials: S
authors.lastname: Manganaro
authors.forename: Bonnie
authors.initials: B
authors.lastname: McKenzie
authors.forename: Lixia
authors.initials: L
authors.lastname: Gao
authors.forename: Michael
authors.initials: M
authors.lastname: Scott
authors.forename: Blaise
authors.initials: B
authors.lastname: Bourgeois
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Kothare
mesh_terms: D000293:Adolescent; D000328:Adult; D002548:Cerebral Revascularization / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D009072:Moyamoya Disease / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult