Original article: aortic surgery symposiumIntraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery
Section snippets
Patients
Fifty-six consecutive patients (female, 26; male, 30; age, 29 to 78 years, mean 67 years) undergoing DTA (n = 25) or TAA (n = 31) repair between August 1996 and October 2001 were included in this study. Each patient had preoperative SSEP baseline studies and gave informed consent for TCES.
MEP recording
MEPs were elicited with TCES applied through spiral needle electrodes placed at C1 and C2 scalp sites (International 10 to 20 System) and recorded from the spinal epidural space (D wave, 16 patients) or
Results
Neurophysiological spinal cord monitoring, combined with other protective adjuncts (eg, retrograde aortic perfusion, CSF drainage, and moderate or deep hypothermia), was performed for 56 patients with DTA (n = 25) or TAA (n = 31) during repair of their aortic aneurysms. In this series of patients, in-hospital mortality was 5.4% (3 of 56 patients). The causes of death include cardiac (n = 1), respiratory (n = 1), and renal failure (n = 1).
Sixteen patients (28.6%) had significant MEP changes (
Comment
In this study, spinal cord function in 56 patients with descending aortic aneurysms was monitored intraoperatively with both SSEPs and MEPs. Sixteen patients had significant MEP changes, among which only 4 patients had delayed accompanying SSEP alteration. Loss of MEPs from the lower extremities suggested anterior cord ischemia and prompted intervention to restore blood supply to the spinal cord. Although 1 developed delayed postoperative paraplegia, all 13 patients with restoration of MEPs
Acknowledgements
We thank Karin Liddle, Nimira Bapoo, and Peter Van Rienen, IOM technologists at Vancouver General Hospital, for their dedicated technical support.
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