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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2022; 09(02): 121-124
DOI: 10.1055/s-0042-1744396
Case Report

Can the Processed EEG Be Utilized as a Cerebral Ischemia Monitor during the Temporary Clip Application in Anterior Circulation Aneurysm Surgery?

Ramamani Mariappan
1   Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
,
Srinivasa B. Krothapalli
2   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
,
Bijesh R. Nair
2   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
,
Benjamin F. Alexander
2   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract

Patients undergoing cerebral aneurysm clipping are at risk for cerebral ischemia. Ischemic tolerance varies among individuals. Hence, multimodal intraoperative neuromonitoring (IONM) is essential. IONM is not available in many centers. This case report highlights the utilization of processed electroencephalography (EEG) as a cerebral ischemia monitor during temporary clip application. Our patient underwent clipping of a ruptured anterior-communicating artery aneurysm. After the temporary clip applications on the right and left, A1 arterial segments led to a transient drop of somatosensory evoked potentials (SSEPs). At the same time, the frontal four-channel processed EEG showed a burst suppression (BS) pattern. Blood pressure augmentation and the removal of temporary clips helped restore the SSEP back to baseline and the disappearance of the BS pattern in processed EEG. During the steady state of anesthesia, the sudden appearance of the BS pattern in processed EEG can be attributed to clip-induced cerebral ischemia after ruling out other potential causes for BS.

Keywords

aneurysm clipping - cerebral ischemia - intraoperative neuromonitoring - four-channel frontal processed EEG - somatosensory evoked potential


Publikationsverlauf

Artikel online veröffentlicht:
05. Mai 2022

© 2022. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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