The role of evoked potential monitoring in operative management of type I and type II thoracoabdominal aortic aneurysms.
Spinal cord ischemia with subsequent paraplegia remains the most dreaded and impressive complication following thoracoabdominal aortic aneurysm repair. Protective measures, such as cerebrospinal fluid drainage, distal aortic perfusion, and epidural cooling, have significantly reduced paraplegia rate. A major impediment is the inability to assess the efficacy of reattaching intercostal arteries or the contributing value of the adjunctive procedures during the operation. Monitoring motor-evoked potentials is a reliable technique to assess spinal cord integrity, dictating surgical strategies to restore and maintain blood supply to the gray matter. Based on motor-evoked potentials, hemodynamic and operative maneuvers during thoracoabdominal aortic aneurysm repair resulted, in our experience, in prevention of neurologic deficit in 98% of patients.
Jacobs
Michael J
MJ
Department of Surgery, University Hospital Maastricht, The Netherlands. m.jacobs@surgery.azm.nl
Mess
Werner H
WH
D017544:Aortic Aneurysm, Abdominal / Q000145:classification* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000145:classification* / Q000601:surgery*; D019468:Disease Management; D019054:Evoked Potentials, Motor; D006801:Humans; D016343:Monitoring, Intraoperative; D010264:Paraplegia / Q000503:physiopathology / Q000517:prevention & control; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D013116:Spinal Cord / Q000502:physiology; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome