Computerized topographic brain mapping during carotid endarterectomy
J. R. Elmore, J. Eldrup-Jorgensen, W. H. Leschey, W. E. Herbert, R. C. Dillihunt and F. S. Ray
Department of Surgery, Maine Medical Center, Portland 04102.
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.
