Optical topography can predict occurrence of watershed infarction during carotid endarterectomy: technical case report

• Published in: Surgical neurology 2009-05, Vol.71 (5), p.540-542
• Main Authors: Nakamura, Shin, MD, Kano, Tsuneo, MD, PhD, Sakatani, Kaoru, MD, DMSc, PhD, Hoshino, Tatsuya, MD, PhD, Fujiwara, Norio, MD, PhD, Murata, Yoshihiro, MD, PhD, Katayama, Yoichi, MD, PhD
• Format: Article
• Language: English
• Subjects: Anterior Cerebral Artery - pathology; Anterior Cerebral Artery - physiopathology; Biological and medical sciences; Biomarkers - analysis; Biomarkers - metabolism; Brain - blood supply; Brain - pathology; Brain - physiopathology; Brain Infarction - diagnosis; Brain Infarction - etiology; Brain Infarction - physiopathology; Brain Mapping - instrumentation; Brain Mapping - methods; Carotid endarterectomy; Carotid Stenosis - surgery; Cerebral Arteries - pathology; Cerebral Arteries - physiopathology; Cerebrovascular Circulation - physiology; Endarterectomy, Carotid - adverse effects; Hemodynamic response, Near infrared spectroscopy, Oxygen metabolism, Optical topography, Watershed-type infarction, Cerebral ischemia; Humans; Intraoperative Complications - diagnosis; Intraoperative Complications - etiology; Intraoperative Complications - physiopathology; Male; Medical sciences; Middle Aged; Middle Cerebral Artery - pathology; Middle Cerebral Artery - physiopathology; Monitoring, Intraoperative - instrumentation; Monitoring, Intraoperative - methods; Neurology; Neurosurgery; Optics and Photonics - instrumentation; Optics and Photonics - methods; Oxygen Consumption - physiology; Oxyhemoglobins - analysis; Oxyhemoglobins - metabolism; Predictive Value of Tests; Risk Factors; Spectroscopy, Near-Infrared - instrumentation; Spectroscopy, Near-Infrared - methods; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2007.11.012

Abstract Background The major risk of CEA is perioperative stroke. NIRS can detect ischemic changes during CEA; however, possible watershed-type perfusion defects may not be detected by single-channel NIRS occurring at some distance from the light source. In the present case, we tested the usefulness of optical topography (ie, multichannel NIRS, OT) for this purpose. Case Description The patient (64-year-old man) exhibited nonsymptomatic 80% stenosis of the right ICA with normal cerebral perfusion. CEA was performed to prevent cerebral infarction. We used single-channel NIRS and OT for monitoring of perfusion changes during CEA. The optodes of OT were placed on the skull to cover the frontal and parietal lobes on the right side, whereas the sensor of the single-channel NIRS was placed on the right forehead. The single-channel NIRS detected no significant perfusion changes during surgery. However, the OT revealed occurrence of watershed-type perfusion defects in the border region between the right middle and posterior cerebral artery supply areas during cross-clamping of the right internal carotid artery. Postoperative MRI showed an ischemic region which corresponded to the area associated with the perfusion defects. Conclusion OT could detect watershed-type posterior perfusion defects which the single-channel NIRS failed to detect. OT may represent a useful tool for intraoperative monitoring during CEA.