Improved spinal cord perfusion during thoracoabdominal aortic repair

Area of Science:

• Neurosurgery
• Cardiovascular Surgery
• Neurophysiology

Background:

• Thoracoabdominal aortic aneurysm repair is complex, carrying a risk of spinal cord injury.
• Intraoperative neurophysiological monitoring is crucial for safeguarding neural structures during such procedures.

Purpose of the Study:

• To assess the efficacy of transcranial motor-evoked potentials (tcMEP) monitoring for early detection of neuronal lesions.
• To determine if tcMEP monitoring facilitates timely interventions to prevent irreversible spinal cord damage.

Main Methods:

• TcMEP monitoring was performed in twelve patients undergoing open surgical thoracoabdominal aortic replacement.
• Standard spinal cord protection strategies included optimizing cardiopulmonary bypass, using catecholamines, managing central venous pressure, reimplanting segmental arteries, and CSF drainage.

Main Results:

• Nine patients experienced loss of tcMEP following segmental aorta clamping.
• Counteractive measures led to tcMEP recovery in five patients.
• One patient developed postoperative paraplegia, associated with persistent tcMEP loss; three patients died intraoperatively.

Conclusions:

• Loss of tcMEP is a significant indicator of spinal cord ischemia.
• TcMEP monitoring is highly effective for the early identification of spinal cord ischemia during thoracoabdominal aortic surgery.
• Prompt recognition via tcMEP enables interventions to mitigate the risk of postoperative paraplegia.