Transintercostal-evoked spinal cord potential in thoracic aortic surgery

Area of Science:

• Neurosurgery
• Cardiovascular Surgery
• Neurophysiology

Background:

• A novel method, transintercostal-evoked spinal cord potential (Tic-ESCP), has been developed for measuring spinal cord-evoked potentials.
• Assessing the feasibility and accuracy of Tic-ESCP during thoracic aortic surgery is crucial for patient safety.

Purpose of the Study:

• To evaluate the clinical feasibility and accuracy of the transintercostal-evoked spinal cord potential (Tic-ESCP) method.
• To compare Tic-ESCP with conventional transcranial motor-evoked potentials (Tc-MEP) during thoracic aortic surgery.

Main Methods:

• Stimulating and recording electrodes were placed on intercostal nerves, alongside conventional cranial and intrathecal electrodes.
• Specially designed hook-type electrodes were used for atraumatic nerve anchoring.
• Transintercostal-evoked spinal cord potential (Tic-ESCP) and transcranial motor-evoked potential (Tc-MEP) were recorded simultaneously in eight patients.

Main Results:

• Tic-ESCP was successfully recorded with clear biphasic waveforms in all patients.
• Changes in Tic-ESCP and Tc-MEP waveforms correlated with aortic reconstruction stages.
• Significant waveform decreases indicated potential spinal cord compromise, guiding interventions and preventing injury in two cases.

Conclusions:

• Transintercostal-evoked spinal cord potential (Tic-ESCP) is clinically feasible and comparable to transcranial motor-evoked potentials (Tc-MEP).
• Tic-ESCP offers simple, specific spinal cord monitoring within the target range, unlike other evoked potentials.