Significance of Brain Protection and Neurophysiological Monitoring in Carotid Endarterectomy.

Shin, Yong Sam; Kim, Sun Ho; Kim, Jong Hoon; Min, Kyung Tae; Kim, Dong Ik; Yoo, Sun Kook; Lee, Kyu Chang

Original Article

Journal of Korean Neurosurgical Society 1998;27(8): 1101-1108.

Yong Sam Shin, Sun Ho Kim, Jong Hoon Kim, Kyung Tae Min, Dong Ik Kim, Sun Kook Yoo, Kyu Chang Lee

¹Department of Neurosurgery, Severance Hospital, Brain Research Institute,College of Medicine, Yonsei University, Seoul, Korea.
²Department of Anesthesiology, Severance Hospital, Brain Research Institute,College of Medicine, Yonsei University, Seoul, Korea.
³Department of Neuroradiology, Severance Hospital, Brain Research Institute,College of Medicine, Yonsei University, Seoul, Korea.
⁴Department of Biomedical Engineering, Severance Hospital, Brain Research Institute,College of Medicine, Yonsei University, Seoul, Korea.

ABSTRACT

We present our results of carotid endarterectomy performed in 12 patients(bilateral in 2 patients) under prospective brain protection-monitoring protocol during the past two years. The protocol consists of induced hypertension, mild hypothermia, and pentothal burst suppression under bipolar two-channel compressed spectral array(CSA) monitoring. Eleven of the 12 patients recovered without any new deficit from the surgery, and this result was expected as their CSA monitoring showed no significant changes. One patient had multiple untreated aneurysms, and therefore, hypertension was not applied. This patient developed significant postoperative neurological deficits correlated well with the CSA changes. One of the major advantages of CSA monitoring is that dosage of thiopental sodium for burst suppression, that varied greatly from 1,016mg to 3,220mg, could be titrated on each patient based upon the CSA findings. Another important benefit of our brain protection-monitoring protocol is that unnecessary shunting procedure could be avoided. In conclusion, brain protection under CSA monitoring could prevent dangerous ischemic insults from circulatory disruption on already vulnerable ischemic hemisphere in patients requiring carotid endarterectomy.

Key Words: Carotid endarterectomy; Brain protection; Compressed spectral array(CSA); Mild hypothermia