Nepal Journal of Neuroscience
Official Journal of Nepalese Society of Neurosurgeons
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www.neson.org.np


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EEG Based Carotid Endarterectomy: A Case Report

Dr Rupendra Adhikari, MBBS
Department of Neurosurgery Norvic International Hospital Thapathali, Kathmandu, Nepal

Abstract
Carotid endarterectomy (CEA) has been performed for over 6 decades for the treatment of stenotic and ulcerative lesions of the carotid artery. It improves the cerebral hypoperfusion caused by stenosis of the carotid artery or may prevents artery to artery embolism from ulceration of the atheroma. Although carotid stenting is getting more popular in the west, CEA is still a viable option in developing countries where interventional neuroradiology is not well developed. We report a case of a 60-year-old female who had several episodes of transient ischemic attacks (TIAs) in the past one month. The symptom included right sided hemiparesis and aphagia together with amourosis fugax. Investigations revealed 80% carotid stenosis of her left internal carotid artery. She underwent CEA under general anesthesia with intraoperative electroencephalography (EEG) monitoring. EEG reading was recorded after induction of general anesthesia, during clamping and after the completion of CEA. Special focus was given on the difference in height and rate of waves between the two hemispheres during clamping. Since there was no difference in right and left sided EEG even after test clamping, CEA procedure was carried out without a shunt. EEG based CEA as a useful tool to determine the need of temporary shunting during CEA surgery. The procedure also placed the surgeon at ease since he knew that the brain was not undergoing ischemia during surgery.

Key Words: Carotid stenosis, CEA, EEG monitoring, TIA