BACKGROUND: Monitoring motor-evoked potentials (MEPs) is an accurate technique to assess spinal cord integrity during thoracoabdominal aortic aneurysm (TAAA) repair, guiding surgical strategies to prevent paraplegia. METHODS: In 210 consecutive patients with type I (n = 75), type II (n = 103), and type III (n = 32) TAAA surgical repair was performed using left heart bypass, cerebrospinal fluid drainage, and MEPs monitoring. RESULTS: Reliable MEPs were registered in all patients. The median total number of patent intercostal and lumbar arteries was five. After proximal aortic crossclamping, MEP decreased below 25% of base line in 72 patients (34%) indicating critical spinal cord ischemia, which could be corrected by increasing distal aortic pressure. By using sequential clamping it appeared that in 43% of type I and II cases spinal cord circulation was supplied between T5 and L1, and 57% between L1 and L5. In type II and III cases cord perfusion was dependent upon lower lumbar arteries in 16% and pelvic circulation in 8%, necessitating reattachment of these segmental arteries. In 9% of patients critical ischemic MEP changes occurred without visible arteries, requiring aortic endarterectomy and selective grafting. One patient suffered early paraplegia and 2 delayed, and 2 patients had temporary neurologic deficit (5 of 210; 2.4%). CONCLUSIONS: In patients with TAAA, blood supply to the spinal cord depends upon a highly variable collateral system. Monitoring MEPs is an accurate technique for detecting cord ischemia, guiding surgical tactics to reduce neurologic deficit (2.4%).
BACKGROUND: Monitoring motor-evoked potentials (MEPs) is an accurate technique to assess spinal cord integrity during thoracoabdominal aortic aneurysm (TAAA) repair, guiding surgical strategies to prevent paraplegia. METHODS: In 210 consecutive patients with type I (n = 75), type II (n = 103), and type III (n = 32) TAAA surgical repair was performed using left heart bypass, cerebrospinal fluid drainage, and MEPs monitoring. RESULTS: Reliable MEPs were registered in all patients. The median total number of patent intercostal and lumbar arteries was five. After proximal aortic crossclamping, MEP decreased below 25% of base line in 72 patients (34%) indicating critical spinal cord ischemia, which could be corrected by increasing distal aortic pressure. By using sequential clamping it appeared that in 43% of type I and II cases spinal cord circulation was supplied between T5 and L1, and 57% between L1 and L5. In type II and III cases cord perfusion was dependent upon lower lumbar arteries in 16% and pelvic circulation in 8%, necessitating reattachment of these segmental arteries. In 9% of patients critical ischemic MEP changes occurred without visible arteries, requiring aortic endarterectomy and selective grafting. One patient suffered early paraplegia and 2 delayed, and 2 patients had temporary neurologic deficit (5 of 210; 2.4%). CONCLUSIONS: In patients with TAAA, blood supply to the spinal cord depends upon a highly variable collateral system. Monitoring MEPs is an accurate technique for detecting cord ischemia, guiding surgical tactics to reduce neurologic deficit (2.4%).
Authors: Stephen D Waterford; Michelle Rastegar; Erin Goodwin; Paul A Lapchak; Viviana Juan; Farnaz Haji; René Bombien; Ali Khoynezhad Journal: Transl Stroke Res Date: 2015-05-20 Impact factor: 6.829
Authors: J J Appoo; H D Gregory; H D Toeg; C A Prusinkiewicz; W D T Kent; A Ferland; D V Ha Journal: HSR Proc Intensive Care Cardiovasc Anesth Date: 2012
Authors: Alexander Gombert; Jochen Grommes; Danny Hilkman; Drosos Kotelis; Werner H Mess; Michael J Jacobs Journal: J Vasc Surg Cases Innov Tech Date: 2018-02-27