title: Neurophysiological monitoring during thoracoabdominal aortic endovascular stent graft implantation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the benefit of neurophysiological monitoring during thoracic and thoracoabdominal endovascular stent graft implantation.
  
  
  METHODS
  The spinal cords of 21 patients undergoing endovascular stent graft implantation on the thoracic and thoracoabdominal aorta were monitored with transcranial motor-evoked potentials (tcMEP) and somatosensory-evoked potentials (SSEP). All patients underwent mild systemic hypothermia (34-35 degrees C), constant cerebrospinal fluid (CSF) pressure and vital parameter monitoring. If CSF pressure exceeded 15 mmHg, CSF-drainage was carried out.
  
  
  RESULTS
  Three of the 21 patients (14%) exhibited short-term loss of tcMEP and SSEP after the deployment of the self-expanding endoprosthesis. We observed an intraoperative recovery of the evoked potentials in all cases. CSF-drainage was necessary in three of them. One patient, whose potentials were stable intraoperatively, developed paraparesis 3 weeks after the intervention.
  
  
  CONCLUSIONS
  Neurophysiological monitoring has proved to be an ideal monitoring method to detect spinal cord ischemia during thoracic and thoracoabdominal endovascular stent graft implantation. Due to the advantages of endovascular therapy (no aortic cross-clamping, continuous distal perfusion, and no reperfusion injury), changes in potentials were seldom observed.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. weigang@ch11.ukl.uni-freiburg.de
authors.forename: Ernst
authors.initials: E
authors.lastname: Weigang
authors.forename: Marc
authors.initials: M
authors.lastname: Hartert
authors.forename: Michael P
authors.initials: MP
authors.lastname: Siegenthaler
authors.forename: Katrin
authors.initials: K
authors.lastname: Pitzer-Hartert
authors.forename: Maximilian
authors.initials: M
authors.lastname: Luehr
authors.forename: Ronen
authors.initials: R
authors.lastname: Sircar
authors.forename: Patrick
authors.initials: P
authors.lastname: von Samson
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D004558:Electric Stimulation / Q000379:methods; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011859:Radiography; D013116:Spinal Cord / Q000503:physiopathology; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D015607:Stents; D016896:Treatment Outcome