NDLI: Benefits of Monitoring Motor-Evoked Potentials during Thoracoabdominal Aortic Aneurysm Repair: Technique of Choice to Assess Spinal Cord Ischemia?

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Benefits of Monitoring Motor-Evoked Potentials during Thoracoabdominal Aortic Aneurysm Repair: Technique of Choice to Assess Spinal Cord Ischemia?

Content Provider	Scilit
Author	Jacobs, Michael J. Haan, Peter De Meylaerts, Sven A. Kalkman, Cor J.
Editor	Mol, Bas A. De
Copyright Year	2000
Description	-Spinal cord ischemic injury following thoracoabdominal aortic aneurysm (TAAA) repair remains the most devastating complication, which still occurs in 10 to 30% of patients, despite protective measures such as distal aortic perfusion, cerebrospinal fluid (CSF) drainage, epidural cooling, and reattachment of intercostal arteries. One of the most important limitations of protective actions is the inability to assess the adequacy of spinal cord perfusion and cord function. We developed a technique to record motor-evoked potentials (MEPs) during thoracoabdominal aortic surgery to assess spinal cord ischemia and evaluate the subsequent protective strategies to prevent neurological deficit. Furthermore, a subpopulation was simultaneously monitored with somatosensory evoked potentials (SSEPs). The surgical protocol included left heart bypass and CSF drainage. When spinal cord ischemia was detected, distal aortic pressure and mean arterial pressure were increased. By means of sequential crossclamping, MEPs were used to identify critical intercostal or lumbar arteries. The results show that monitoring of MEPs allows accurate assessment of spinal cord ischemia. SSEP monitoring does not offer additional benefit because of delayed ischemia detection and a high incidence of false-positive and false-negative results. Surgical stragegies based on MEPs prevented neurological deficits in 97% of patients treated for type I and II TAAA.
Related Links	http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-2000-9977.pdf
Ending Page	0016
Page Count	16
Starting Page	0001
ISSN	15310035
e-ISSN	15215768
DOI	10.1055/s-2000-9977
Journal	Perspectives in Vascular Surgery and Endovascular Therapy
Issue Number	Number 2
Volume Number	13
Language	English
Publisher	Georg Thieme Verlag KG
Publisher Date	2000-12-31
Access Restriction	Open
Subject Keyword	Journal: Perspectives in Vascular Surgery and Endovascular Therapy Keyword Thoracoabdominal Aortic Aneurysm Neurological Deficits Motor-evoked Potentials
Content Type	Text
Resource Type	Article
Subject	Surgery Cardiology and Cardiovascular Medicine

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