Electrophysiologic Monitoring during Surgery to Repair the Thoracoabdominal Aorta

Sloan, Tod B.

doi:10.1177/108925320400800205

Cited by 16 publications

(11 citation statements)

References 32 publications

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“…36 Furthermore, MEPs may be more sensitive to ischemia than SSEPs and less likely to deteriorate after midline myelotomy, unlike SSEPs. 4,5,7,10,12,24,[34][35][36]40 Also, as demonstrated in this case, not only will MEPs often be present in neurologically compromised patients, 9 but they may also be able to detect subclinical deficits, 3,23,38 whereas SSEPs are significantly more likely to be absent in the normal and compromised neurological states. In a recent prospective trial, 38.7% of patients undergoing a variety of spinal procedures had either significantly diminished or absent tibial SSEPs.…”

Section: Discussionmentioning

confidence: 56%

Human motor evoked potential responses following spinal cord transection: an in vivo study

Nair

Ramakrishna

Song³

et al. 2010

FOC

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Motor evoked potential (MEP) monitoring has been used increasingly in conjunction with somatosensory evoked potential monitoring to monitor neurological changes during complex spinal operations. No published report has demonstrated the effects of segmental spinal cord transection on MEP monitoring. The authors describe the case of an 11-year-old girl with lumbar myelomeningocele and worsening thoracolumbar scoliosis who underwent a T11–L5 fusion and spinal transection to prevent tethering. Intraoperative MEP and somatosensory evoked potential monitoring were performed, and the spinal cord was transected in 4 quadrants. The MEPs were lost unilaterally as each anterior quadrant was sectioned. This is the first reported case that demonstrates the link between spinal cord transection and MEP signaling characteristics. Furthermore, it demonstrates the relatively minor input of the ipsilateral ventral corticospinal tract in MEP physiology at the thoracolumbar junction. Finally, this study further supports the use of MEPs as a specific intraoperative neuromonitoring tool.

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Section: Discussionmentioning

confidence: 56%

Human motor evoked potential responses following spinal cord transection: an in vivo study

Nair

Ramakrishna

Song³

et al. 2010

FOC

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“…Ischemic insults during the intraoperative or postoperative periods can result from intraoperative hypotension, blood loss, the loss of critical intercostal arteries that are occluded or intentionally sacrificed during repair, aortic cross-clamping, or increased intracerebral pressure. Failure to prevent or rapidly detect spinal cord ischemia frequently results in permanent paraplegia, which can occur rapidly and depends on the severity of the loss of perfusion (Katz et al 1981;Livesay et al 1985;Connolly 1998;McGarvey et al 2007;Sloan and Jameson 2007). Surgical and anesthetic attempts to prevent paralysis include Deep Hypothermic Circulatory Arrest (DHCA), epidural spinal cooling, elevation in MAP (mean arterial pressure), removal of CSF with a lumbar drain, augmentation of distal aortic perfusion using partial bypass, intercostal artery re-implantation, and adjunct pharmacologic measures (Gloviczki 2002).…”

Section: Detection Of Intraoperative Ischemia During Thoracic Aneurysmentioning

confidence: 99%

Heat shock proteins as biomarkers for the rapid detection of brain and spinal cord ischemia: a review and comparison to other methods of detection in thoracic aneurysm repair

Hecker

McGarvey

2011

Cell Stress and Chaperones

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The heat shock proteins (HSPs) are members of highly conserved families of molecular chaperones that have multiple roles in vivo. We discuss the HSPs in general, and Hsp70 and Hsp27 in particular, and their rapid induction by severe stress in the context of tissue and organ expression in physiology and disease. We describe the current state of knowledge of the relationship and interactions between extra-and intracellular HSPs and describe mechanisms and significance of extracellular expression of HSPs. We focus on the role of the heat shock proteins as biomarkers of central nervous system (CNS) ischemia and other severe stressors and discuss recent and novel technologies for rapid measurement of proteins in vivo and ex vivo. The HSPs are compared to other proposed small molecule biomarkers for detection of CNS injury and to other methods of detecting brain and spinal cord ischemia in real time. While other biomarkers may be of use in prognosis and in design of appropriate therapies, none appears to be as rapid as the HSPs; therefore, no other measurement appears to be of use in the immediate detection of ongoing severe ischemia with the intention to immediately intervene to reduce the severity or risk of permanent damage.

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“…Die verzöger ten Defizite entstehen nicht nur durch ei ne instabile Hämodynamik, sondern auch durch Ödembildung im Rückenmarkbe reich und Embolisierung oder Throm bosierung der reanastomosierten Arte rien [37,38]. Allerdings ist es schwer, den genauen Zeitpunkt der Entstehung eines neurologischen Defizits und die Fakto ren, die dazu beigetragen haben, zu be stimmen.…”

Section: Postoperativ Auftretende Neurologische Defiziteunclassified

Epidurale Kühlung

Tschöp

Czerner²,

Nuscheler³

et al. 2008

Anaesthesist

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The risk of paraplegia and paraparesis during thoracoabdominal aneurysm surgery still represents a major threat. In 1993, Cambria and coworkers applied for the first time a method of regional spinal cord hypothermia by epidural cooling and significantly diminished the rate of neurological deficits. In this article the first clinical application of this neuroprotective method in Germany will be reported. This neuroprotective method was used in seven patients who underwent elective thoracoabdominal aortic aneurysm repair. The spinal cord was cooled with ice-cold saline via an epidural catheter during surgical repair. Cerebrospinal fluid pressure was measured on-line via a spinal catheter and controlled using active cerebrospinal fluid drainage. Of these seven patients, four showed no postoperative neurological deficit and were released from hospital. The other three patients died in the intra-operative or post-operative phase due to complications other than spinal cord injury arising from pre-existing comorbid conditions. The described method of epidural cooling represents a preliminary experimental method, which might reduce spinal cord injury during surgical repair of thoracoabdominal aneurysms.

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Electrophysiologic Monitoring during Surgery to Repair the Thoracoabdominal Aorta

Cited by 16 publications

References 32 publications

Human motor evoked potential responses following spinal cord transection: an in vivo study

Human motor evoked potential responses following spinal cord transection: an in vivo study

Heat shock proteins as biomarkers for the rapid detection of brain and spinal cord ischemia: a review and comparison to other methods of detection in thoracic aneurysm repair

Epidurale Kühlung

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