Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair

Abstract

SSEP and MEP monitoring were highly correlated only when intraoperative changes were irreversible. Reversible changes were not significantly associated with immediate neurologic deficit. Irreversible changes were significantly associated with immediate neurologic deficit, and the findings were identical for SSEP and MEP in this variable, indicating that the more complex MEP measures do not add further information to that obtained from SSEP. Normal SSEP and MEP findings had a strong negative predictive value, indicating that patients without signal loss are unlikely to awake with neurologic deficit.

Assessment of intraoperative motor evoked potentials for predicting postoperative paraplegia in thoracic and thoracoabdominal aortic aneurysm repair

“…Although the specificity in this study is comparable with other reports [10][11][12], more efforts to decrease the falsepositive rate are necessary. We set the cutoff point for detecting SCI at 75% decrease of the baseline MEP in the TA muscle on the side contralateral to femoral artery cannulation, in accordance with the report of Jacobs et al [6].…”

Frequency-Domain Objective Response Detection Techniques Applied to Evoked Potentials: A Review

“…The somatosensory evoked potential (SEP) is often obtained by applying electric current pulses and is useful for detecting peripheral nerve lesions, plexopathies and radiculopathies (Linden et al, 1997), and for monitoring vascular and spine surgeries such as desobstruction of the carotid artery (Liu et al, 2010), aortic aneurism repair (Keyhani et al, 2009, Van Dongen et al, 2001, aortic coarctation repair (Faberowski et al, 1999), scoliosis correction procedures (Cruccu et al, 2008) and lumbar pedicle screw placement for in situ posterior spinal fusion (Gundanna, 2003), due to its sensitivity to mechanical stress, hypotension and ischemia.…”

“…Among many applications, the VEP is commonly applied for visual acuity evaluation of infants and newborns (Linden et al, 1997); the AEP is often used for monitoring the depth of anesthesia (Cagy, 2003) and auditory screening of newborns (Ramos et al, 2000); whilst the SEP is frequently employed for monitoring spine (Cruccu et al, 2008) and vascular surgeries (Keyhani et al, 2009).…”

Setting up and utilizing a service for measuring perioperative transcranial motor evoked potentials during thoracoabdominal aortic surgery and thoracic endovascular repair

“…The risk of paraplegia has persisted in most published series [1,2] despite adjuncts such as sequential clamping, left heart bypass, deep hypothermic circulatory arrest (DHCA), intercostal artery reattachment and cerebrospinal fluid drainage (CSFD). Intraoperative monitoring of spinal cord function has been adopted by several groups internationally to guide the conduct of the operation in this patient group [3][4][5]. Two approaches are available: transcranial motor evoked potential (tcMEP) and/or somatosensory evoked potentials (SSEP).…”

“…Our group has concentrated on using a tcMEP system as in the absence of neurophysiology input tcMEPs are easier to set up and interpret. Spinal cord monitoring has been delivered with input from neurophysiologists and the debate in the literature has centred around the relative merits of SSEPs versus MEPs [4,6]. Little if any information exists on the practical issues of setting up such a service, managing patients safely using this technology and informing potential users of pitfalls and safeguards.…”