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Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion
Published on: December 10, 2020
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Spinal Cord Protection for Thoracoabdominal Aortic Surgery
Lydia K Miller1, Virendra I Patel2, Gebhard Wagener1
1Department of Anesthesiology, Columbia University, New York, NY.
Journal of Cardiothoracic and Vascular Anesthesia
|August 9, 2021
Summary
Surgical repair of thoracic aortic aneurysms carries a risk of paralysis. Spinal cord protection strategies, including cerebrospinal fluid drainage, can mitigate this risk but require careful consideration of potential complications.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Anesthesiology
Background:
- Descending thoracic and thoracoabdominal aortic repairs carry a significant risk of spinal cord injury (SCI), leading to paraplegia.
- While endovascular repairs may have a lower SCI incidence, randomized trials are lacking to confirm this.
- Paraplegia results from impaired collateral blood supply to the anterior spinal artery.
Purpose of the Study:
- To review current surgical management of descending thoracic and thoracoabdominal aortic disease.
- To discuss the incidence and risk factors for SCI in these procedures.
- To outline spinal cord protection protocols, focusing on cerebrospinal fluid (CSF) drainage for anesthesiologists.
Main Methods:
- Review of current literature on thoracic aortic disease management and SCI.
- Analysis of risk factors and incidence of SCI in open and endovascular repairs.
- Discussion of perioperative protocols for SCI mitigation, including CSF drainage.
Main Results:
- Perioperative protocols, including CSF drainage, hypotension avoidance, and neurophysiologic monitoring, can reduce SCI risk.
- Cerebrospinal fluid drainage improves spinal cord perfusion pressure, decreasing ischemia risk.
- Potential risks of CSF drainage, such as bleeding, must be balanced against its benefits.
Conclusions:
- Spinal cord protection is crucial during thoracic aortic repairs.
- Cerebrospinal fluid drainage is a key component of SCI prevention protocols.
- A multidisciplinary approach involving surgeons and anesthesiologists is essential for optimizing patient outcomes and minimizing SCI risk.
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