Cerebral monitoring in carotid surgery. Results of a questionnaire in the Federal Republic of Germany

Abstract

A standardized questionnaire was used to find out if and what kind of intraoperative cerebral monitoring method, respectively, is practised for carotid surgery in Germany. Out of 351 hospitals having received the questionnaire, 251 (75.1 %) answered the questions. 43 hospitals had not performed any carotid surgery in 1998, so 208 questionnaires remained for further analysis. In 43.3 % (n = 90), hospitals did not practise any kind of cerebral monitoring. In contrast, most hospitals monitored cerebral function and/or cerebral haemodynamics, intraoperatively. Median nerve somatosensory evoked potentials (SEP; n = 60) and electroencephalography (EEG; n = 39) dominated, whereas carotid stump pressure measuring (n = 40), transcranial Doppler sonography (TCD; n = 10), cerebral venous oximetry (n = 8) and near-infrared spectroscopy (n = 4) were used less frequently. In 60 hospitals, the indication to install temporary intraluminal shunting was based primarily on monitoring results. The results of our study mirror the present practice of intraoperative cerebral monitoring for carotid surgery in Germany. SEP monitoring is preferable because this method can reveal an imminent cerebral ischaemia with high sensitivity and specifity. TCD and cerebral oximetry are less suitable for this purpose. Measuring carotid stump pressure is not recommendable to reflect the status of cerebral haemodynamics, however this method is still in frequent use. Recommendations whether to practise cerebral monitoring or not, and what method should be used for this purpose, cannot be given presently.