Improved spinal cord perfusion during thoracoabdominal aortic repair.
OBJECTIVE
The study's aim is to evaluate whether intraoperative neurophysiological monitoring with transcranial motor-evoked potentials (tcMEP) permits early recognition of neuronal lesions, thus making interventions to prevent irreversible spinal cord damage possible.


METHODS
TcMEP monitoring was carried out in twelve patients (mean age 60 years) during open surgical thoracoabdominal aortic replacement. Current approaches for corrective, spinal cord-protecting interventions consist of: raising distal perfusion by increasing cardiopulmonary bypass (CPB) flow, catecholamine application, reducing central venous pressure, reimplantation of segmental arteries, and cerebrospinal fluid (CSF) drainage.


RESULTS
Nine patients exhibited loss of tcMEP after segmental aorta clamping. In five patients we observed a recovery of tcMEP through counteractive measures. Three patients died intraoperatively, one patient presented with postoperative paraplegia and loss of tcMEP.


CONCLUSIONS
TcMEP loss is associated with spinal cord ischaemia, causing postoperative paraplegia. TcMEP monitoring is an excellent method to detect spinal cord ischaemia at an early stage.
Weigang
E
E
Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany. weigang@ch11.ukl.uni-freiburg.de
Hartert
M
M
von Samson
P
P
Pechstein
U
U
Genstorfer
J
J
Pitzer
K
K
Zentner
J
J
Beyersdorf
F
F
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D004558:Electric Stimulation; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009044:Motor Cortex / Q000502:physiology*; D009431:Neural Conduction / Q000502:physiology*; D010264:Paraplegia / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D013119:Spinal Cord Injuries / Q000517:prevention & control*; D020760:Spinal Cord Ischemia / Q000175:diagnosis*