A 54-year-old man with a pulsatile mass on the right side of his neck suffered left hemiparesis due to cerebral infarction in the right cerebral hemisphere. Three-dimensional computed tomographic angiography revealed an aneurysm located at the origin of the right cervical internal carotid artery (ICA). On magnetic resonance (MR) imaging, the aneurysm included fresh and organized thrombi. Under intraoperative monitoring of transcranial Doppler (TCD), transcranial cerebral oxygen saturation (cSO2) and electroencephalogram (EEG), the aneurysm was removed and the right common carotid artery (CCA) and ICA were anastomosed using interposition graft of expanded polytetrafluoroethylene. Attempts were made to keep systolic blood pressure during surgery above a +10% increase. Microembolic signals developed on TCD during dissection of the aneurysm, and then the CCA was early clamped. Transcranial cSO2 on the right forehead and EEG showed no abnormal change throughout surgery. Postoperatively, MR imaging revealed two asymptomatic spotty ischemic lesions, and the patient had only hoarseness.
The present case suggests that intentional hypertension and monitoring of TCD, transcranial cSO2 and EEG during surgery might minimize development of intraoperative ischemic events due to embolism from the surgical site and carotid clamping.
