Decreased Unilateral Regional Cerebral Oxygen Saturation Caused by the Hemi-clamshell Approach：A Case Report

Abstract

A 55-year-old man was diagnosed with right lung cancer concomitant with invasion of the left atrium. The patient was scheduled for resection of the right upper lobe and S6 and partial resection of the left atrium using cardiopulmonary bypass（CPB）. We intraoperatively monitored the patient’s bilateral regional cerebral oxygen saturation（rSO₂）because of the use of CPB. When the surgeons peeled the lung off from the thoracic wall by the hemi-clamshell approach, only right rSO₂ decreased with no remarkable change in other vital signs and parameters including blood pressure and CVP. We suspected that lifting up the thoracic wall resulted in stenosis of the right common carotid artery, which induced right-sided cerebral ischemia. After we released it, the right rSO₂ value soon recovered. After the operation, the patient had no neurologic complications. rSO₂ should be monitored when using the hemi-clamshell approach for detecting cerebral desaturation due to brain malperfusion.