Transcranial magnetic stimulation: use of motor evoked potentials in the evaluation of surgically induced spinal cord ischemia.
We evaluated transcranial magnetic stimulation producing motor evoked potentials (TMS MEP) as a method to detect spinal cord ischemia during surgery for thoracoabdominal aneurysms. Four groups of swine were subjected to different types of surgically-induced ischemia. TMS MEP and neurological function were assessed at baseline, immediately after the ischemic insult and after four hours of reperfusion/post-ligation. Cross-clamping of the aorta in groups A&B resulted in the disappearance and subsequent reappearance of TMS MEP with significantly prolonged latencies in most animals and variable neurological function. Ligation of intercostal arteries produced no changes in TMS MEP or neurological function (group C). However, after ligation of intercostal and lumbar arteries, group D demonstrated no reappearance of TMS MEP and severe neurological deficits. TMS MEP can provide rapid detection of global spinal cord ischemia and can also predict local devascularization injury.
Qayumi
K A
KA
Department of Surgery, University of British Columbia, Vancouver, Canada.
Janusz
M T
MT
Jamieson
E W
EW
Chow
V D
VD
Dry
G M
GM
D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D003250:Constriction; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D007431:Intraoperative Complications / Q000175:diagnosis; D007511:Ischemia / Q000175:diagnosis* / Q000503:physiopathology*; D016343:Monitoring, Intraoperative / Q000379:methods; D011930:Reaction Time; D013116:Spinal Cord / Q000098:blood supply* / Q000503:physiopathology; D013552:Swine; D050781:Transcranial Magnetic Stimulation