• Alba Díaz-Baamonde, Roberto Peláez-Cruz, Maria J Téllez, John Lantis, and Sedat Ulkatan.
• Mount Sinai Roosevelt, Mount Sinai West Medical Center, New York, NY, USA. albadiazbaa@gmail.com.
• J Clin Monit Comput. 2023 Apr 1; 37 (2): 699704699-704.

AbstractHead positioning in carotid surgery represents an often overlooked but sensitive period in the surgical plan. A 53-year-old male presented a significant decrement in median nerve somatosensory evoked potential (mSEP) following head and neck positioning for carotid pseudoaneurysm repair before skin incision.Neurophysiological monitoring was performed with mSEP and electroencephalography early during the patient's preparation and surgery. Within five minutes after rotation and extension of the head to properly expose the surgical field, the contralateral m-SEP significantly decreased in both cortical (N20/P25) and subcortical (P14/N18) components. Partial neck correction led to m-SEP improvement, allowing to proceed with the carotid repair. We discuss possible underlying pathophysiological mechanisms responsible for these changes and highlight the relevance of an early start on monitoring to avoid neurological deficits.© 2022. The Author(s), under exclusive licence to Springer Nature B.V.

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