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Intraoperative neurophysiological monitoring during urgent surgical extracranial internal carotid artery recanalization

S. Ostrý, M. Nevšímal, M. Reiser, R. Voldřich, O. Krtička, J. Kubále, M. Nevšímalová, J. Fiedler

. 2022 ; 138 (-) : 221-230. [pub] 20220214

Jazyk angličtina Země Nizozemsko

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc22018122

OBJECTIVE: The clinical outcome of surgical extracranial internal carotid artery (eICA) recanalization may be adversely affected by intraoperative ischemia. Median nerve somatosensory evoked potential (SEP) amplitude correlates well with cerebral blood flow. Our study presents the value of intraoperative SEP and selective shunting in the prevention of intraoperative ischemia development during urgent eICA recanalization. METHODS: Prospective recruitment of patients with acute unilateral eICA occlusion. All underwent surgical recanalization with intraoperative monitoring of scalp median SEPs. Preoperative clinical findings, cerebral collaterals, and 3 month functional outcome were evaluated. RESULTS: The cohort consisted of 33 patients. Intraoperative SEP amplitude decreased significantly in 6 (18.2%). An intraluminal shunt was inserted twice (6.1%), surgical complications occurred in 6 (18.2%), intracerebral hemorrhage was not found. Favorable outcome 3 months after surgery according to the modified Rankin scale (mRS 0-2) was achieved in 28 (84.8%), 3 patients died (9.1%). CONCLUSIONS: Intraoperative SEP during urgent eICA recanalization seems to be beneficial. Thanks to the effective measure based on the intraoperative SEP changes, the clinical outcome in four(12.1%) could be positively affected. SIGNIFICANCE: The results suggest that selective shunting based on intraoperative median SEPs may prevent intraoperative ischemia and may improve overall outcome of urgent eICA recanalization.

Citace poskytuje Crossref.org

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$a Ostrý, Svatopluk $u Department of Neurology, České Budějovice Hospital, Czech Republic; Department of Neurosurgery and Neurooncology First Faculty of Medicine Charles University in Prague and Military University Hospital Prague, Czech Republic; Institute of Physiotherapy and Selected Medical Disciplines, Faculty of Health and Social Studies, University of South Bohemia in České Budějovice, J. Boreckého 1167/27, 370 11 České Budějovice, Czech Republic. Electronic address: ostry@nemcb.cz
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$a Intraoperative neurophysiological monitoring during urgent surgical extracranial internal carotid artery recanalization / $c S. Ostrý, M. Nevšímal, M. Reiser, R. Voldřich, O. Krtička, J. Kubále, M. Nevšímalová, J. Fiedler
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$a OBJECTIVE: The clinical outcome of surgical extracranial internal carotid artery (eICA) recanalization may be adversely affected by intraoperative ischemia. Median nerve somatosensory evoked potential (SEP) amplitude correlates well with cerebral blood flow. Our study presents the value of intraoperative SEP and selective shunting in the prevention of intraoperative ischemia development during urgent eICA recanalization. METHODS: Prospective recruitment of patients with acute unilateral eICA occlusion. All underwent surgical recanalization with intraoperative monitoring of scalp median SEPs. Preoperative clinical findings, cerebral collaterals, and 3 month functional outcome were evaluated. RESULTS: The cohort consisted of 33 patients. Intraoperative SEP amplitude decreased significantly in 6 (18.2%). An intraluminal shunt was inserted twice (6.1%), surgical complications occurred in 6 (18.2%), intracerebral hemorrhage was not found. Favorable outcome 3 months after surgery according to the modified Rankin scale (mRS 0-2) was achieved in 28 (84.8%), 3 patients died (9.1%). CONCLUSIONS: Intraoperative SEP during urgent eICA recanalization seems to be beneficial. Thanks to the effective measure based on the intraoperative SEP changes, the clinical outcome in four(12.1%) could be positively affected. SIGNIFICANCE: The results suggest that selective shunting based on intraoperative median SEPs may prevent intraoperative ischemia and may improve overall outcome of urgent eICA recanalization.
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$a Nevšímal, Milan $u Department of Neurosurgery, České Budějovice Hospital, Czech Republic. Electronic address: nevsimal.milan@nemcb.cz
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$a Reiser, Martin $u Department of Neurology, České Budějovice Hospital, Czech Republic. Electronic address: reiser.martin@nemcb.cz
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$a Voldřich, Richard $u Department of Neurosurgery and Neurooncology First Faculty of Medicine Charles University in Prague and Military University Hospital Prague, Czech Republic. Electronic address: richard.voldrich@uvn.cz
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$a Krtička, Ondřej $u Department of Neurology, České Budějovice Hospital, Czech Republic. Electronic address: krticka.ondrej@nemcb.cz
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$a Kubále, Jiří $u Department of Radiology, České Budějovice Hospital, Czech Republic. Electronic address: kubale.jiri@nemcb.cz
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$a Nevšímalová, Miroslava $u Department of Neurology, České Budějovice Hospital, Czech Republic. Electronic address: nevsimalova.miroslava@nemcb.cz
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$a Fiedler, Jiří $u Department of Neurosurgery, České Budějovice Hospital, Czech Republic; Department of Neurosurgery, Faculty of Medicine in Plzeň, Charles University in Prague, Czech Republic. Electronic address: fiedler@nemcb.cz
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