Skip to main content

Advertisement

SpringerLink
Log in

Delayed response of transcranial myogenic motor-evoked potential monitoring to spinal cord ischemia during repair surgery for descending thoracic aortic aneurysm

  • Clinical Report
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

The efficacy of transcranial myogenic motor-evoked potential (tc-MEP) monitoring during thoracic aortic surgery has been the subject of some reports, because tc-MEP monitoring can rapidly reflect changes in spinal cord blood flow during thoracic aortic cross-clamping. In this article, we present a case in which delayed loss of tc-MEP signals was observed after cross-clamping of the descending thoracic aorta. We must be aware that tc-MEPs recorded from the lower extremities can fail to provide rapid detection of spinal cord ischemia in the upper thoracic level after cross-clamping of the descending thoracic aorta.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993;17:357–368.

    Article  PubMed  CAS  Google Scholar 

  2. Meylaerts SA, Jacobs MJ, van Iterson V, de Haan P, Kalkman CJ. Comparison of transcranial motor evoked potentials and somatosensory evoked potentials during thoracoabdominal aortic aneurysm repair. Ann Surg. 1999;230:742–749.

    Article  PubMed  CAS  Google Scholar 

  3. de Haan P, Kalkman CJ, De Mol BA, Ubags LH, Veldman DJ, Jacobs MJ. Efficacy of transcranial motor-evoked myogenic potentials to detect spinal cord ischemia during operations for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg. 1997;113:87–100.

    Article  PubMed  Google Scholar 

  4. Kakinohana M, Kawabata T, Miyata Y, Sugahara K. Myogenic transcranial motor evoked potentials monitoring cannot always predict neurological outcome after spinal cord ischemia in rats. J Thorac Cardiovasc Surg. 2005;129:46–52.

    Article  PubMed  Google Scholar 

  5. Kakinohana M, Nakamura S, Fuchigami T, Miyata Y, Sugahara K. Influence of the descending thoracic aortic cross clamping on bispectral index value and plasma propofol concentration in humans. Anesthesiology. 2006;104:939–943.

    Article  PubMed  Google Scholar 

  6. Machida M, Weinstein SL, Yamada T, Kimura J, Toriyama S. Dissociation of muscle action potentials and spinal somatosensory evoked potentials after ischemic damage of spinal cord. Spine. 1988;13:1119–1124.

    Article  PubMed  CAS  Google Scholar 

  7. Gharagozloo F, Neville RF Jr, Cox JL. Spinal cord protection during surgical procedures on the descending thoracic and thoracoabdominal aorta: a critical overview. Semin Thorac Cardiovasc Surg. 1998;10:73–86.

    PubMed  CAS  Google Scholar 

  8. Elger CE, Speckmann EJ, Caspers H, Janzen RWC. Corticospinal connections in the rat. I. Monosynaptic and polysynaptic responses of cervical motorneurons to epicortical stimulation. Exp Brain Res. 1977;28:385–404.

    Article  PubMed  CAS  Google Scholar 

  9. Fehlings MG, Tator CH, Dean Linden R, Riper IR. Motor evoked potentials recorded from normal and spinal cord-injured rats. Neurosurgery. 1987;20:125–130.

    Article  PubMed  CAS  Google Scholar 

  10. Ryder J, Zappulla R, Nieves J. Motor evoked potentials elicited from pyramidal stimulation and recorded from the spinal cord in the rat. Neurosurgery. 1991;28:550–558.

    Article  PubMed  CAS  Google Scholar 

  11. de Haan P, Kalkman CJ. Spinal cord monitoring: somatosensory-and motor-evoked potentials. Anesthesiol Clin North America. 2001;19:923–945.

    Article  PubMed  Google Scholar 

  12. Brown RH, Nash CL, Berilla JA, Amaddio MD. Cortical evoked potential monitoring: a system for intraoperative monitoring of spinal cord function. Spine. 1984;9:256–261.

    Article  PubMed  CAS  Google Scholar 

  13. Lips J, de Haan P, de Jager SW, Vanicky I, Jacobs MJ, Kalkman CJ. The role of transcranial motor evoked potentials in predicting neurologic and histopathologic outcome after experimental spinal cord ischemia. Anesthesiology. 2002;97:183–191.

    Article  PubMed  Google Scholar 

  14. Urban M. Spinal cord ischemia. Recognition and prevention. In: Black TJJ, editor. Neuroprotection. Baltimore: Williams & Wilkins; 1997. p. 135–162.

    Google Scholar 

  15. Charagozloo F, Larson J, Dausmann MJ, Neville RF Jr, Gomes MN. Spinal cord protection during surgical procedures on the descending thoracic and thoracoabdominal aorta: review of current techniques. Chest. 1997;109:799–809.

    Article  Google Scholar 

  16. Domisse GF. The blood supply of the spinal cord: a critical vascular zone in spinal surgery. J Bone Joint Surg. 1974;56B:225–235.

    Google Scholar 

  17. Miyairi T, Kotsuka Y, Morota T, Kubota H, Shibata K, Ikeda Y, et al. Paraplegia after open surgery using endovascular stent graft for aortic arch aneurysm. J Thorac Cardiovasc Surg. 2001;121:1240–1243.

    Article  Google Scholar 

  18. Crawford ES, Crawford JL, Safi HJ, Coselli JS, Hess KR, Brooks B, Norton HJ, Glaeser DH. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg. 1986;3:389–404.

    Article  PubMed  CAS  Google Scholar 

  19. Konard PE, Tacker WA, Levy WJ, Reedy DP, Cook JR, Greddes LA. Motor evoked potentials in dog: effects of global ischemia on spinal cord and peripheral nerve signals. Neurosurgery. 1987;20:117–124.

    Google Scholar 

  20. Lips J, de Haan P, Bouma GJ, Jacobs MJ, Kalkman CJ. Delayed detection of motor pathway dysfunction after selective reduction of thoracic spinal cord blood flow in pigs. J Thorac Cardiovasc Surg. 2002;123:531–538.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan

    Manabu Kakinohana, Masanori Abe, Yuji Miyata, Masakatsu Oshiro, Satoko Saikawa & Kazuhiro Sugahara

  2. Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan

    Katsuya Arakaki & Yukio Kuniyoshi

Authors
  1. Manabu Kakinohana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masanori Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuji Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masakatsu Oshiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoko Saikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsuya Arakaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yukio Kuniyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kazuhiro Sugahara
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Kakinohana, M., Abe, M., Miyata, Y. et al. Delayed response of transcranial myogenic motor-evoked potential monitoring to spinal cord ischemia during repair surgery for descending thoracic aortic aneurysm. J Anesth 22, 304–307 (2008). https://doi.org/10.1007/s00540-008-0633-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-008-0633-3

Key words

Search

Navigation