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Evaluation of patients undergoing extra-intracranial arterial bypass surgery based on CT-scanning and neurophysiological studies

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Summary

In order to evaluate short-term effects of extra-intracranial arterial bypass procedure (EIAB) on cerebral function, we performed neurophysiological studies, combined with CT-evaluation, on 17 patients undergoing EIAB, pre- and postoperatively.

CT helps to define, on a morphological basis, the extent of ischemic brain damage, and is, in some cases, a valuable tool in preoperatively assessing chances for a recovery.

EEG shows, 2 weeks after surgery, in 50% of the patients after completed stroke, worsening of ischemic lesions as a result of reduced intraoperative cerebral perfusion and/or temporary occlusion of the recipient cortical vessel.

Amongst somatosensory evoked potentials (SEP), and relative and absolute response periods (RPrel/ RPabs), RP abs and RPrel seem to have the highest potential in predicting later outcome in patients with TIA/RIND, while no correlation could be found between neurophysiological data and later clinical course for the completed stroke group (Table II).

Zusammenfassung

Um kurzfristige Veränderungen der Gehirnfunktion zu erfassen, die durch die extra — intrakranielle Bypassoperation bewirkt wurden, untersuchten wir 17 Patienten vor und nach dieser Operation mittels neurophysiologischer und röntgen — computertomographischer Untersuchungsmethoden.

Die Computertomographie hilft auf morphologischer Grundlage das Ausmaß des ischämischen Hirnschadens zu bestimmen und ist in einigen Fällen ein wertvolles Hilfsmittel, um vor der Operation die Chancen für eine klinische Befundbesserung abzuschätzen.

Die Elektroenzephalographie zeigt bei der Hälfte der Patienten nach einem Hirninfarkt 2 Wochen nach der Operation, daß der ischämische Schaden zugenommen hat (Zunahme eines Herdhinweises), wohl bedingt durch die herabgesetzte intraoperative Hirndurchblutung bzw. den temporären Verschluß der anastomosierten Kortikalarterie.

Unter den angewandten neurophysiologischen Untersuchungsmethoden (somatosensorisch evozierte Potentiale, relative und absolute Reizantwortperiode) scheinen die absolute und relative Reizantwortperiode am ehesten geeignet, bei Patienten mit passagerem neurologischem Defizit die spätere Entwicklung abzuschätzen. Hingegen fand sich keine Korrelation zwischen neurophysiologischen Untersuchungsergebnissen und späterem Verlauf der klinischen Symptomatik für die Gruppe der Hirninfarktpatienten (Tab. II).

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Authors and Affiliations

  1. Neurochirurgische Klinik, Universitäts-Klinikum Essen, Hufelandstraße 55, 4300, Essen, Germany

    H. M. Mehdorn & W. Grote

  2. Dept. of Neurology, University of Essen Medical Center, Hufelandstr. 55, 4300, Essen 1, FRC

    J. Jörg

  3. Institute of Radiology, University of Essen Medical Center, Hufelandstr. 55, 4300, Essen 1, FRC

    H. Ch. Nahser

Authors
  1. H. M. Mehdorn
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  2. J. Jörg
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  3. H. Ch. Nahser
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  4. W. Grote
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Dedicated to Professor K. J. Zülch on the occasion of his 70th birthday.

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Mehdorn, H.M., Jörg, J., Nahser, H.C. et al. Evaluation of patients undergoing extra-intracranial arterial bypass surgery based on CT-scanning and neurophysiological studies. Neurosurg. Rev. 3, 165–171 (1980). https://doi.org/10.1007/BF01647124

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