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Selective intercostal arterial perfusion during thoracoabdominal aortic aneurysm surgery
1First Department of Surgery, Hiroshima University School of Medicine, Japan. sueda@mcai.med.hirosjima-u.ac.jp
The Annals of Thoracic Surgery
|August 2, 2000
Summary
Monitoring motor evoked potentials (MEPs) during selective intercostal artery perfusion in thoracoabdominal aortic aneurysm (TAAA) repair effectively prevents paraplegia. This neurophysiological monitoring ensures spinal cord safety during complex aortic surgeries.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Thoracoabdominal aortic aneurysm (TAAA) repair poses risks of spinal cord injury and subsequent paraplegia.
- Selective intercostal arterial perfusion is a technique used to maintain spinal cord blood supply during TAAA repair.
- Evaluating neurophysiological monitoring methods is crucial for improving surgical outcomes.
Purpose of the Study:
- To assess changes in motor evoked potentials (MEPs) and evoked spinal cord potentials (ESCPs) during selective intercostal arterial perfusion in TAAA repair.
- To determine the efficacy of this perfusion strategy in preventing postoperative paraplegia.
Main Methods:
- The study monitored MEPs and ESCPs elicited by direct cortical and spinal cord stimulation.
- Selective intercostal arterial perfusion was performed using a Dacron graft from T7 to L1.
- Monitoring occurred during the prosthetic replacement phase in five TAAA cases.
Main Results:
- MEP amplitude transiently decreased upon aortic clamping but rapidly recovered with selective intercostal perfusion.
- ESCPs remained stable throughout the intercostal artery reconstruction.
- No patients experienced postoperative paraplegia or paraparesis.
Conclusions:
- Monitoring MEPs is a valuable tool for preventing paraplegia in TAAA surgery.
- Selective intercostal arterial perfusion, combined with MEP monitoring, enhances spinal cord protection during TAAA repair.