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Spinal cord stimulation evoked potentials during thoracoabdominal aortic aneurysm surgery
B Drenger1, S D Parker, R W McPherson
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
Anesthesiology
|May 1, 1992
Summary
Monitoring spinal cord evoked potentials during aortic surgery can predict neurological outcomes. Loss of these signals, especially with maintained perfusion, correlates with adverse events, aiding in real-time neural function assessment.
Area of Science:
- Neurosurgery
- Neurology
- Cardiovascular Surgery
Background:
- Somatosensory evoked potentials (SEPs) monitor neural function during thoracoabdominal aortic aneurysm (TAAA) surgery.
- Peripheral nerve stimulation for SEPs can produce false positives.
- Direct spinal cord stimulation (SCS) was explored to improve accuracy.
Purpose of the Study:
- To compare scalp-recorded evoked potentials from peripheral nerve stimulation versus direct spinal cord stimulation.
- To assess the utility of these methods in predicting neurological outcomes during TAAA repair.
Main Methods:
- Compared posterior tibial nerve stimulation with epidural electrode spinal cord stimulation in 18 patients.
- Monitored evoked potential changes during aortic clamping.
- Correlated evoked potential loss with neurological deficits.
Main Results:
- Peripheral evoked potentials disappeared in 10/10 patients without distal perfusion.
- Spinal cord stimulation evoked potentials disappeared permanently in 2/18 patients, correlating with paraplegia and death.
- Loss of evoked potentials accurately predicted outcome in 1 paralyzed patient with maintained perfusion.
- Gradual decrease in amplitude and increase in latency observed during clamping.
Conclusions:
- Loss of spinal cord stimulation evoked potentials correlates with adverse neurological outcomes.
- Maintaining adequate distal perfusion is crucial for the reliability of evoked potential monitoring.
- Evoked potentials can aid in assessing spinal cord ischemia during TAAA surgery.