title: Intraoperative Changes in Cerebrospinal Fluid Gas Tensions Reflect Paraplegia During Thoracoabdominal Aortic Surgery: A Proof-of-Principle Study.
abstract: BACKGROUND
  In this study, gas tensions in cerebrospinal fluid (CSF) were prospectively evaluated as intraoperative markers for the detection of neurological deficits.
  
  
  METHODS
  Spinal fluid, serum, and heart lung machine (HLM) perfusate were monitored for gas tensions (po 2/pCo 2) and related parameters (pH, lactate, and glucose) during thoracoabdominal aortic repair and correlated with perioperative neurological examination and electrophysiological testing.
  
  
  RESULTS
  Forty-seven patients were assessed for the study, and 40 consecutive patients were finally included. The patients were divided into 3 groups: group A (23 patients, 57.5%): no clinical or laboratory signs of neurological damage; group B (14 patients, 35%) who developed subclinical deficits; and group C (3 patients, 7.5%) who had paraplegia. Significant intraoperative changes in CSF gas tensions were observed with postoperative paraplegia. Glucose ratio between serum and CSF showed higher variability in group C, confirming a damage of the blood-brain barrier (BBB).
  
  
  CONCLUSIONS
  Major neurological damage is reflected by early changes in CSF gas tensions and glucose variability, suggesting damage of the BBB in these patients.
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany fleissner.felix@mh-hannover.de.
authors.forename: Felix
authors.initials: F
authors.lastname: Fleissner
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Redwan
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
authors.affiliation: Department of Neurology, Hannover Medical School, Hannover, Germany.
authors.forename: Anna-Lena
authors.initials: AL
authors.lastname: Boeck
authors.affiliation: Department of Neurology, Hannover Medical School, Hannover, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Weissenborn
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Omke E
authors.initials: OE
authors.lastname: Teebken
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Pichlmaier
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Martens
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001812:Blood-Brain Barrier / Q000378:metabolism; D002245:Carbon Dioxide / Q000134:cerebrospinal fluid*; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D006863:Hydrogen-Ion Concentration; D064795:Intraoperative Neurophysiological Monitoring; D019344:Lactic Acid / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010100:Oxygen / Q000134:cerebrospinal fluid*; D010264:Paraplegia / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D002245:Carbon Dioxide; D019344:Lactic Acid; D005947:Glucose; D010100:Oxygen
keywords: CSF drainage; paraplegia; thoracoabdominal aortic repair