The colour density spectral array in the perioperative management of urgent craniectomy: can we identify epileptiform activity?

Abstract

tatus epilepticus (SE) represents a diagnostic and treatment challenge in comatosed patients. This clinic report represents one of the first descriptions of the use of Bilateral BIS® monitor to depict the changes of colour density spectral array (CDSA) from the operating room to the intensive care unit (ICU), and allowed us to hypothesize about the presence of epileptiform activity.
A 45 years old man submitted to an urgent craniotomy directed to decompress a malignant middle cerebral artery infarct. Initial CDSA panel showed a pattern of asymmetry, related to the left hemisphere, where the ischemic-hemorrhagic lesion was located. A pattern of high power at frequencies under the 12Hz range was observed, resulting in a plateau formation that can imply seizure presence. This pattern responded to changing of Ce of target controlled infusion (TCI) Propofol and to a bolus of thiopental. At encephalic decompression a global reduction of activity at all frequencies was observed. The patient was transferred to the ICU where the DSA panel showed a sudden loss of alpha and then delta band frequencies. Cerebral death was afterwards clinically diagnosed. CDSA can be used as a complementary tool to detect and monitor SE. It shows good correlation with surgical events and anesthetic depth making it possible to tailor anesthesia to each patient needs in the operating room and in the ICU.