Protection against ischemic spinal cord injury: One-shot perfusion cooling and percutaneous topical cooling

Transcranial motor-evoked potentials following intra-aortic cold blood infusion facilitates detection of critical supplying artery of spinal cord☆

“…The mechanisms of amplitude decrease may be related to local hypothermia by cold blood (4 8C). In an experimental study, intra-aortic infusion of cold lactated Ringer's solution (3 8C) cooled the spinal cord by 6-7 8C [17]. Hypothermia induces a depression of the electrophysiologic response of both cerebral and peripheral neurologic activity [18,19].…”

“…Hypothermia induces a depression of the electrophysiologic response of both cerebral and peripheral neurologic activity [18,19]. This topical cooling of spinal cord might induce the rapid decrease of Tc-MEP amplitude [17][18][19].…”

Strategies for Spinal Cord Protection during Descending Thoracic and Thoracoabdominal Aortic Surgery: Up-to-date Experimental and Clinical Results - A review

“…Cooling of the spinal cord has been carried out in the experimental and clinical setting by perfusion through the intercostal and lumbar vessels (122,123), subdural space (57,78), and epidural space (77,124,125), by applying a cold pack on the lumbar area (123,126) and through retrograde venous perfusion of the spinal cord (127)(128)(129). Cambria et al (77) recently reported a series of 170 patients who underwent descending or thoracoabdominal aortic aneurysm repair employing the adjuncts of epidural cooling, reimplantation of intercostal arteries from T8 to L1 by an inclusion botton or beleved anastomosis (but only in 61% of patients with type I and II aneurysms), and cerebrospinal uid pressure monitoring and drainage to maintain its pressure below 12 mmHg, followed by passive cerebrospinal uid drainage for 48 h. The authors succeeded in achieving a mean cerebrospinal uid temperature of 26.4°C during aortic cross-clamping, the mean core temperature being 35.0°C.…”

“…A decrease of about 2°C in the rectal temperature was also noted in the local hypothermia group. A previous experimental study in a rabbit model of spinal cord ischemia by Ueno et al (123) showed that much lower spinal cord temperatures can be achieved with local cold packing which in turn is associated with largely better neurological outcome than perfusion cooling of the spinal cord. These observations not only con rm the neuroprotective effects of local hypothermia, but also that it can be safely achieved by an easy, noninvasive method such as lumbar cold packing, thus avoiding also the complications potentially associated with other invasive methods.…”

New method for absolute spinal cord ischemia protection in rabbits

“…Various techniques for spinal cord cooling have been developed in many experimental and clinical trials. [8][9][10] We previously developed a cooling pad that can efficiently cool the spinal cord. 11 However, a longer aortic clamping time of Ն20 minutes correlates with more severe spinal cord ischemia and the occurrence of delayed-onset paraplegia.…”