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Related Experiment Video

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Neuromonitoring during descending aorta procedures.

Mirela V Simon1, Charles C Dong2, Michael J Jacobs3

  • 1Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.

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|June 30, 2022
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Summary

Intraoperative neurophysiology monitoring, including somatosensory and motor evoked potentials (SEP/MEP), helps prevent spinal cord injury during thoraco-abdominal aneurysm (TAA) repair. This technique guides management to avoid neurological deficits.

Keywords:
Intra-operative neurophysiologyMotor evoked potentialsParaplegiaSomatosensory evoked potentialsStrokeThoracoabdominal aneurysm repair

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Area of Science:

  • Neurology
  • Cardiovascular Surgery
  • Neurophysiology

Background:

  • Thoraco-abdominal aneurysm (TAA) repair poses a high risk of spinal cord infarction due to potential disruption of segmental arteries.
  • Cerebral infarction is also a risk during TAA repair due to manipulation of the aorta.

Purpose of the Study:

  • To highlight the role of intraoperative neurophysiological monitoring in preventing neurological deficits after TAA repair.
  • To present a multimodality approach for open TAA monitoring.

Main Methods:

  • Utilizing intraoperative neurophysiology, specifically somatosensory evoked potentials (SEP) and motor evoked potentials (MEP), to assess spinal cord perfusion.
  • Employing electroencephalography (EEG) monitoring for cerebral protection and ischemia detection.
  • Integrating these techniques for comprehensive perioperative management.

Main Results:

  • SEP and MEP monitoring effectively assess collateral blood flow, detect reversible spinal cord ischemia, and guide interventions.
  • EEG monitoring can evaluate cerebral cooling efficacy and detect cerebral ischemia.
  • Multimodality monitoring aids in diagnosing ischemia, managing blood pressure, guiding artery re-implantation, and optimizing postoperative hemodynamics.

Conclusions:

  • Intraoperative neurophysiological monitoring is crucial for preventing paraplegia after TAA repair.
  • A multimodality approach combining SEP, MEP, and EEG monitoring offers a versatile strategy to prevent postoperative neurological deficits.