Somatosensory evoked potentials and spinal cord perfusion pressure are significant predictors of postoperative neurologic dysfunction.
Paraplegia after thoracoabdominal aneurysm repair can occur in 3% to 40% of patients. This study investigated the efficacy of cerebrospinal fluid (CSF) drainage to protect the spinal cord during aortic cross-clamping (AXC) and the interrelationship between drainage, spinal cord perfusion pressure (SCPP), and changes in somatosensory evoked potentials (SEP) in a canine model of spinal cord ischemia. SCPP was defined as the mean distal aortic pressure minus the CSF pressure. In the experimental group, CSF was drained before AXC. SEP changes were quantitated as time to latency increase of 10% (L-10) and time to complete SEP loss. Drainage of CSF had no significant effect on the distal aortic pressure but significantly increased SCPP from 9.4 to 21.8 mm Hg and decreased the incidence of postoperative neurologic injury. Ischemic SEP changes were highly significant predictors of postoperative neurologic injury, occurring more than two times earlier in the paralyzed and paraparetic animals. Dogs without neurologic injury had significantly higher SCPP, delayed L-10 time, and delayed SEP loss.
Grubbs
P E
PE
Dept. of Surgery, Maimonides Medical Center, Brooklyn, NY 11219.
Marini
C
C
Toporoff
B
B
Nathan
I
I
Basu
S
S
Acinapura
A J
AJ
Cunningham
J N
JN
D000818:Animals; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery; D002555:Cerebrospinal Fluid / Q000502:physiology*; D003250:Constriction; D004285:Dogs; D005073:Evoked Potentials, Somatosensory; D006439:Hemodynamics; D007511:Ischemia / Q000503:physiopathology; D010264:Paraplegia / Q000503:physiopathology; D010477:Perfusion; D011183:Postoperative Complications / Q000503:physiopathology; D011237:Predictive Value of Tests; D011312:Pressure; D013116:Spinal Cord / Q000098:blood supply*