Histopathological effects on epidural tissue of bolus or continuous infusions through an epidural catheter in ewes

Türe, Hatice; Etı, Zeynep; Göğüş, F. Yılmaz; Düzgün, Oktay; Mutlu, Zihni; Karabağli, P

doi:10.1111/j.1365-2044.2010.06309.x

Cited by 2 publications

(2 citation statements)

References 19 publications

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“…Kaplan [32], Moomiaie [33], and Bockler [34] describe the use of the sheep model for detecting interruption of spinal cord blood flow during aortic cross-clamping. Numerous reports exist for the testing of the epidural approach for anesthesia and for attempts at protecting against spinal ischemia in sheep [35-39]. In the sheep, the vertebral processes can be more easily palpated than in the pig, another model used in spinal cord research.…”

Section: Methodsmentioning

confidence: 99%

Optical Monitoring and Detection of Spinal Cord Ischemia

et al. 2013

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Spinal cord ischemia can lead to paralysis or paraparesis, but if detected early it may be amenable to treatment. Current methods use evoked potentials for detection of spinal cord ischemia, a decades old technology whose warning signs are indirect and significantly delayed from the onset of ischemia. Here we introduce and demonstrate a prototype fiber optic device that directly measures spinal cord blood flow and oxygenation. This technical advance in neurological monitoring promises a new standard of care for detection of spinal cord ischemia and the opportunity for early intervention. We demonstrate the probe in an adult Dorset sheep model. Both open and percutaneous approaches were evaluated during pharmacologic, physiological, and mechanical interventions designed to induce variations in spinal cord blood flow and oxygenation. The induced variations were rapidly and reproducibly detected, demonstrating direct measurement of spinal cord ischemia in real-time. In the future, this form of hemodynamic spinal cord diagnosis could significantly improve monitoring and management in a broad range of patients, including those undergoing thoracic and abdominal aortic revascularization, spine stabilization procedures for scoliosis and trauma, spinal cord tumor resection, and those requiring management of spinal cord injury in intensive care settings.

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Section: Methodsmentioning

confidence: 99%

Optical Monitoring and Detection of Spinal Cord Ischemia

et al. 2013

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“…Despite the epidural location, aspiration of 2 mL via the CAP was possible. It seems that, despite low-volume infusion, epidural fluid accumulation occurs when tissue absorption is insufficient, which is likely related to epidural fibrosis as a result of long-term infusion (30)(31)(32).…”

Section: Cap-ct Myelographymentioning

confidence: 99%

Catheter Access Port (Computed Tomography) Myelography in Intrathecal Drug Delivery Troubleshooting: A Case Series of 70 Procedures

Delhaas

Harhangi

Frankema

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objectives: Intrathecal drug delivery is used for the treatment of intractable spasticity, dystonia, and pain. When the symptomatology fails to respond to therapy, the cause could be failure of the medication infusion. The purpose of this study is to assess pump catheter access port (CAP)-myelography and CAP-CT-myelography as advanced imaging methods in treatment failure. Materials and Methods: We analyzed observational routinely collected data of 70 CAP procedures with 2D/3D reconstructions and additional imaging of 53 adult patients where the cause of treatment was unclear between November 2013 and November 2018. CAP-myelography and CAP-CT myelography were performed with postprocessing 2D/3D reconstructions. When myelography could not be obtained or when the result did not reveal the cause of the treatment failure, additional procedures, such as noncontrast CT, MRI, lumbar puncture CT, and 111Indium-DTPA SPECT-CT, were performed. Results: CAP fluid aspiration prior to contrast medium injection was not possible (N = 17). In one case, contrast was injected into the pump pocket unintentionally (N = 1). Of 70 procedures, 24% were unaspiratable. The remaining CAP myelography examinations (N = 52) had limited value for the diagnosis. CAP-CT myelography (N = 50) was normal (N = 31). The abnormal results (N = 19) were dorsal dural leak (N = 5), subdural catheter position (N = 2), limited rostral flow of contrast material (N = 4), limited and abnormal contrast distribution (N = 3), obstruction of rostral flow (N = 2), a leak at the pump-catheter connection (N = 1), and a sheared catheter localized in the pump pocket (N = 2). Limited contrast distributions were found to be false positive findings (N = 2). Four normal CT-CAP myelographic procedures were false negatives, as the reference tests revealed a cause of intrathecal drug delivery (ITDD) failure. The CAP-CT procedures resulted in a sensitivity of 81% (17/21) and a specificity of 93% (27/29). Conclusions: CAP-CT myelography with 2D/3D reconstructions is an essential step in the diagnostic algorithm for cases involving ITDD failure.

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Histopathological effects on epidural tissue of bolus or continuous infusions through an epidural catheter in ewes

Cited by 2 publications

References 19 publications

Optical Monitoring and Detection of Spinal Cord Ischemia

Optical Monitoring and Detection of Spinal Cord Ischemia

Catheter Access Port (Computed Tomography) Myelography in Intrathecal Drug Delivery Troubleshooting: A Case Series of 70 Procedures

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