Value and pitfalls of neurophysiological monitoring in thoracic and thoracoabdominal aortic replacement and endovascular repair.
BACKGROUND
The aim of our study was to analyze the neurophysiological monitoring method with regard to its potential problems during thoracic and thoracoabdominal aortic open or endovascular repair. Furthermore, preventive strategies to the main pitfalls with this method were developed.


METHODS
Between 11/2000 and 05/2007 in 97 cases open surgery or endovascular stentgraft-implantation was performed on the thoracic or thoracoabdominal aorta. Intraoperatively, neurophysiologic motor- and somatosensory-evoked potentials were monitored.


RESULTS
Our cases were divided into four groups: event-free patients with normal potentials (A, 63 cases), with correlation of modified evoked potentials and neurological outcome (B, 14 cases), false-positive or false-negative results (C, 4 cases), and medication interaction or technical issues (D, 16 cases). We observed a sensitivity of 93 % and a specificity of 96 % for the neurophysiological monitoring.


CONCLUSIONS
Monitoring spinal cord function during surgical and endovascular interventions on the thoracic and thoracoabdominal aorta is necessary. It can be made more effective by precisely analyzing the interference factors of the neurophysiological monitoring method itself. Successful strategies of immediate troubleshooting could be identified.
ter Wolbeek
C
C
Cardiovascular Surgery, University Cardiovascular Center Freiburg-Bad Krozingen, Freiburg, Germany.
Hartert
M
M
Conzelmann
L O
LO
Peivandi
A A
AA
Czerny
M
M
Gottardi
R
R
Beyersdorf
F
F
Weigang
E
E
D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D003943:Diagnostic Techniques, Neurological / Q000009:adverse effects; D004558:Electric Stimulation; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D015607:Stents; D016896:Treatment Outcome