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Vascular surgery

  • Situation

    In thromboendarterectomy (TEA), the standard procedure for the surgical removal of carotid stenosis (constriction), the A. carotis is temporarily opened and must be clamped. If the brain areas dependent on blood supply through the affected carotid cannot be supplied enough oxygen via the contralateral vessels, there is a risk of ischemic (lack of oxygen) brain damage. 

  • Neuromonitoring

    Sensory evoked potentials (SEP) recorded in neuromonitoring make critical changes visible and enable the surgeon to adapt the surgical strategy to prevent post-operative neurological deficits.For the assessment of changes in the oxygen supply to the brain due to a clamped A. carotis, somatosensory evoked potentials (SSEP) are measured continuously. Any changes are compared to the normal signal recorded just after anaesthesia was induced - the baseline signal.

  • Nerve stimulation

    An SEP is triggered by the stimulation of the N. medianus at the wrist and recorded at the hemisphere (brain half) contralateral to the operation site. If oxygen levels drop as a result of reduced perfusion (oxygen supply) of the brain, characteristic changes in amplitude and latency will alert the surgeon who can then take action (e.g. introduce a shunt).

  • Signal recording

    Evoked potentials are minute signals. When recorded at the cortex, they are drowned out by significantly stronger EEG signals. A specific averaging technique is used to extract the signals relevant to the assessment of cortical potentials.

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