title: A New Combined Technique Reducing the Risk of Paraplegia during Thoracoabdominal Aorta Replacement.
abstract: Acute spinal cord ischemia during thoracoabdominal aorta replacement is a dreadful complication. Existing tools (motor evoked potential [MEP] and somatosensory evoked potential [SSEP]) do not allow differentiating between central and peripheral paraplegia. Therefore, the surgeon often performs unnecessary reimplantation of intercostal arteries: this is time consuming, and significantly increases bleeding complications. We present a simple technique combining MEP and peripheral compound muscle action potential induced by posterior tibialis nerve stimulation, enabling the surgeon to quickly discriminate between central and peripheral neurologic injury. The surgeon has one more tool to drive in real time the optimal surgical strategy. This strategy guides the decision as to which side branches ought to be reimplanted, thus minimizing the risk of paraplegia.
authors.affiliation: Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
authors.affiliation: Département de Neurosciences Cliniques, Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Etienne
authors.initials: E
authors.lastname: Pralong
authors.affiliation: Departement des Services de Chirurgie et Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, VD, Switzerland.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gronchi
authors.affiliation: Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Siniscalchi
mesh_terms: D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004558:Electric Stimulation; D019054:Evoked Potentials, Motor; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D061886:Neuromuscular Monitoring; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012092:Replantation; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013895:Thoracic Arteries / Q000601:surgery; D013979:Tibial Nerve; D020196:Trauma, Nervous System / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome; D057188:Workflow