Carotid Endarterectomy
PROCEDURE
Vascular surgery for removal of plaque deposit at or near the bifurcation of either the left or right carotid artery
ELECTRODES
Corkscrew Electrodes - 16: Fz, Cz, CP3, CP4, CS5, GND; F3, C3, P3, T3, T5, F4, C4, P4, T4, T6
Electrode Pairs - 4 (9); Thenar/Hypothenar, Extensor Hallucis/Abductor Hallucis, Median Nerve x 2, Posterior Tibial Nerve x 2, GND
MODALITIES
EMG - Thenar/Hypothenar for assurance of laterality in addition to potential light activity
tEMG - not used
SEP - Median Nerve, Posterior Tibial Nerve, bilateral, cortical and subcortical
MEP - not used
EEG - 8 Channels for lateralizing events and confirmation of burst suppression
T04 - not used
NOTES:
The role of intraoperative neuromonitoring is to identify possible ischemic events during the clamping of the carotid artery to ensure proper blood profusion to the brain.
METHODS
Establish baseline SEP and EEG prior to incision. After vascular clampling, automatic SEP and continuous EEG confirm proper cortical profusion.
NOTES
Median Nerve SEP for high-amplitude responses run automatically beginning just before clamping to observe any changes. The surgeon may want the patient's EEG to reflect burst suppression. Once the plaque is removed, SEPs are continually run in automatic mode until closure of carotid artery and removal of clamps for approximately 10 minutes afterwards in which SEPs can be run manually until skin closure.
Vascular surgery for removal of plaque deposit at or near the bifurcation of either the left or right carotid artery
ELECTRODES
Corkscrew Electrodes - 16: Fz, Cz, CP3, CP4, CS5, GND; F3, C3, P3, T3, T5, F4, C4, P4, T4, T6
Electrode Pairs - 4 (9); Thenar/Hypothenar, Extensor Hallucis/Abductor Hallucis, Median Nerve x 2, Posterior Tibial Nerve x 2, GND
MODALITIES
EMG - Thenar/Hypothenar for assurance of laterality in addition to potential light activity
tEMG - not used
SEP - Median Nerve, Posterior Tibial Nerve, bilateral, cortical and subcortical
MEP - not used
EEG - 8 Channels for lateralizing events and confirmation of burst suppression
T04 - not used
NOTES:
The role of intraoperative neuromonitoring is to identify possible ischemic events during the clamping of the carotid artery to ensure proper blood profusion to the brain.
METHODS
Establish baseline SEP and EEG prior to incision. After vascular clampling, automatic SEP and continuous EEG confirm proper cortical profusion.
NOTES
Median Nerve SEP for high-amplitude responses run automatically beginning just before clamping to observe any changes. The surgeon may want the patient's EEG to reflect burst suppression. Once the plaque is removed, SEPs are continually run in automatic mode until closure of carotid artery and removal of clamps for approximately 10 minutes afterwards in which SEPs can be run manually until skin closure.