Thiel A, Russ W, Nestle H W, Hempelmann G
Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University, Giessen, FRG.
Thorac Cardiovasc Surg. 1989 Apr;37(2):115-8. doi: 10.1055/s-2007-1020301.
Cerebral function during carotid endarterectomy can reliably be monitored using somatosensory evoked potentials (SEP). Transcranial Doppler sonography (TCD) is a noninvasive method providing on-line data about cerebral hemodynamics. The combination of both techniques during carotid surgery is helpful in evaluating the hemodynamic ("input") and the functional ("output") consequences of carotid clamping within a short time. In the present report, combined TCD and SEP monitoring early detected left hemispheric ischemia in a 68-year-old woman subjected to left carotid endarterectomy. The impairment of cerebral perfusion occurred before carotid clamping due to an intraoperative thrombosis of the left internal carotid artery as could be revealed after declamping. A temporary shunt was not inserted. Postoperatively, the patient had a new transient neurological deficit. In this case, TCD correctly indicated cerebral ischemia as confirmed by SEP recording. For carotid artery surgery, combined TCD and SEP may be helpful in detecting those patients who will profit from temporary shunting if this is not done routinely.
在颈动脉内膜切除术期间，可使用体感诱发电位（SEP）可靠地监测脑功能。经颅多普勒超声检查（TCD）是一种可提供有关脑血流动力学在线数据的非侵入性方法。在颈动脉手术期间联合使用这两种技术有助于在短时间内评估颈动脉夹闭的血流动力学（“输入”）和功能（“输出”）后果。在本报告中，联合TCD和SEP监测在一名接受左颈动脉内膜切除术的68岁女性中早期检测到左半球缺血。由于左颈内动脉术中血栓形成，脑灌注受损发生在颈动脉夹闭之前，这在松开夹闭后得以揭示。未插入临时分流管。术后，患者出现了新的短暂性神经功能缺损。在这种情况下，TCD正确地指示了脑缺血，SEP记录证实了这一点。对于颈动脉手术，联合TCD和SEP可能有助于检测那些如果不常规进行临时分流将从临时分流中获益的患者。
