title: Transesophageal versus transcranial motor evoked potentials to monitor spinal cord ischemia.
abstract: OBJECTIVE
  We have previously reported that transesophageal motor evoked potential is feasible and more stable than transcranial motor evoked potential. This study aimed to investigate the efficacy of transesophageal motor evoked potential to monitor spinal cord ischemia.
  
  
  METHODS
  Transesophageal and transcranial motor evoked potentials were recorded in 13 anesthetized dogs at the bilateral forelimbs, anal sphincters, and hindlimbs. Spinal cord ischemia was induced by aortic balloon occlusion at the 8th to 10th thoracic vertebra level. In the 12 animals with motor evoked potential disappearance, occlusion was maintained for 10 minutes (n = 6) or 40 minutes (n = 6) after motor evoked potential disappearance. Neurologic function was evaluated by Tarlov score at 24 and 48 hours postoperatively.
  
  
  RESULTS
  Time to disappearance of bilateral motor evoked potentials was quicker in transesophageal motor evoked potentials than in transcranial motor evoked potentials at anal sphincters (6.9 ± 3.1 minutes vs 8.3 ± 3.4 minutes, P = .02) and hindlimbs (5.7 ± 1.9 minutes vs 7.1 ± 2.7 minutes, P = .008). Hindlimb function was normal in all dogs in the 10-minute occlusion group, and motor evoked potentials recovery (>75% on both sides) after reperfusion was quicker in transesophageal motor evoked potentials than transcranial motor evoked potentials at hindlimbs (14.8 ± 5.6 minutes vs 24.7 ± 8.2 minutes, P = .001). At anal sphincters, transesophageal motor evoked potentials always reappeared (>25%), but transcranial motor evoked potentials did not in 3 of 6 dogs. In the 40-minute occlusion group, hindlimb motor evoked potentials did not reappear in 4 dogs with paraplegia. Among the 2 remaining dogs, 1 with paraparesis (Tarlov 3) showed delayed recovery (>75%) of hindlimb motor evoked potentials without reappearance of anal sphincter motor evoked potentials. In another dog with spastic paraplegia, transesophageal motor evoked potentials from the hindlimbs remained less than 20%, whereas transcranial motor evoked potentials showed recovery (>75%).
  
  
  CONCLUSIONS
  Transesophageal motor evoked potentials may be superior to transcranial motor evoked potentials in terms of quicker response to spinal cord ischemia and better prognostic value.
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Tsuda
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan. Electronic address: shiyanor@hama-med.ac.jp.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Shiiya
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takahashi
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohkura
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan.
authors.forename: Katsushi
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kando
authors.affiliation: Department of Pathology, Seirei Hamamatsu Hospital, Naka-ku, Hamamatsu, Shizuoka, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004947:Esophagus / Q000294:innervation*; D019054:Evoked Potentials, Motor; D018482:Muscle, Skeletal / Q000294:innervation*; D009460:Neurologic Examination; D011930:Reaction Time; D013116:Spinal Cord / Q000503:physiopathology*; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D013997:Time Factors; D065908:Transcranial Direct Current Stimulation
keywords: aortic surgery; motor evoked potentials; spinal cord ischemia