Early detection of cranial nerve dysfunction during carotid endarterectomy through intraoperative neurophysiological monitoring

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY Clinical Neurophysiology Pub Date : 2025-02-01 DOI:10.1016/j.clinph.2025.01.013

Alba León Jorba , Alina Velescu , Núria Álvarez López-Herrero , Anna Mases Fernández , Lorena Romero Montana , Albert Clarà Velasco

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引用次数: 0

Abstract

Objective

Intraoperative neurophysiological monitoring (IONM) is used to detect cerebral ischemia during carotid endarterectomy (CEA). IONM of cranial nerves during CEA has been reported anecdotally. The aim of this study was to assess the use of IONM in identifying and preventing cranial nerve damage during CEA.

Methods

Prospective and observational study from a cohort of 81 patients undergoing CEA. Cranial nerve IONM was performed using electromyography (EMG), corticobulbar motor evoked potentials (CoMEP) and mapping techniques. Responses from spinal accessory, vagus, hypoglossal and facial nerves were recorded.

Results

CoMEP changes were detected in 49 patients (60.4 %). Most were related to indirect retraction and normalized at the end of the procedure. In 11 (13.5 %) cases, CoMEP changes persisted at the conclusion of the surgery, and 9 (11.1 %) of them showed a postoperative paresis. All patients normalized the neurological examination within a year. Cranial nerve mapping identified functional atypical nerve branches anterior to the carotid axis.

Conclusion

IONM is a safe and reliable tool for detecting cranial nerve injuries during CEA and may allow to assess the functionality of surgically inconvenient nerve branches.

Significance

IONM plays a critical role in detecting and potentially preventing cranial nerve damage during CEA leading to better surgical practices.

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来源期刊

Clinical Neurophysiology 医学-临床神经学

CiteScore

8.70

自引率

6.40%

发文量

932

审稿时长

59 days

期刊介绍： As of January 1999, The journal Electroencephalography and Clinical Neurophysiology, and its two sections Electromyography and Motor Control and Evoked Potentials have amalgamated to become this journal - Clinical Neurophysiology. Clinical Neurophysiology is the official journal of the International Federation of Clinical Neurophysiology, the Brazilian Society of Clinical Neurophysiology, the Czech Society of Clinical Neurophysiology, the Italian Clinical Neurophysiology Society and the International Society of Intraoperative Neurophysiology.The journal is dedicated to fostering research and disseminating information on all aspects of both normal and abnormal functioning of the nervous system. The key aim of the publication is to disseminate scholarly reports on the pathophysiology underlying diseases of the central and peripheral nervous system of human patients. Clinical trials that use neurophysiological measures to document change are encouraged, as are manuscripts reporting data on integrated neuroimaging of central nervous function including, but not limited to, functional MRI, MEG, EEG, PET and other neuroimaging modalities.