Neuromonitoring Using Motor and Somatosensory Evoked Potentials in Aortic Surgery

Liu, Lucy; Callahan, Brooke; Peterß, Sven; Dumfarth, Julia; Tranquilli, Maryann; Ziganshin, Bulat A.; Elefteriades, John A.

doi:10.1111/jocs.12739

Cited by 37 publications

(11 citation statements)

References 21 publications

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“…117 Both MEP and the less well investigated SSEP neuromonitoring have been found useful in the prevention and prediction of paraplegia. 118,119 In a retrospective analysis, MEP was found useful in simultaneous arch and TA aortic surgery as part of a protocolized brain and spinal cord protection bundle. 120 The selective use of MEP and SSEP monitoring in aortic arch surgical or endovascular repair may therefore be considered based on the requirements of the individual patient, surgery or procedure, on the urgency of the procedure and on institutional resources.…”

Section: Central Nervous System Electrophysiological Function Monitoringmentioning

confidence: 99%

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Czerny¹,

Schmidli²,

Adler³

et al. 2019

European Journal of Vascular and Endovascular Surgery

255

122

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Section: Central Nervous System Electrophysiological Function Monitoringmentioning

confidence: 99%

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Czerny¹,

Schmidli²,

Adler³

et al. 2019

European Journal of Vascular and Endovascular Surgery

255

122

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“…The relationship between changes in MEP at an early reversible stage and the pathological damage of anterior horn motor neurons was also investigated. Previous studies have demonstrated that MEPs are highly sensitive to SCI when recorded from muscles in the lower extremities ( 35 , 36 ). A study by de Haan et al ( 15 ) demonstrated that myogenic responses disappeared within 2 min after the initiation of arterial occlusion in rabbits.…”

Section: Discussionmentioning

confidence: 99%

Changes in transcranial electrical motor‑evoked potentials during the early and reversible stage of permanent spinal cord ischemia predict spinal cord injury in a rabbit animal model

et al. 2017

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The present study examined changes in the transcranial electrical motor-evoked potentials (TceMEP) waveform to predict neurological deficits and histopathological changes during the early and reversible stage of different levels of permanent spinal cord ischemic injury in a rabbit animal model. A total of 24 New Zealand rabbits were randomly divided into four groups of 6 rabbits each. Group 1 underwent a ligation of the lumbar artery at three levels (L1-L3), group 2 underwent a ligation of the lumbar artery at four levels (L1-L4) and group 3 underwent a ligation of the lumbar artery at five levels (L1-L5). The sham group contained 6 rabbits and did not receive ligation. TceMEP was recorded within 5 min of ligation and, 2 days later, motor function was assessed and the spinal cords were removed for histological examination. Following spinal cord injury, the relationship between variations in the TceMEP waveform and motor function and pathological damage was analyzed. It was observed that the amplitude of TceMEP began to decrease within 1 min of lumbar artery ligation and that the amplitude stabilized within 5 min. These amplitude changes that occurred within 5 min of different levels of permanent spinal cord ischemic injury were positively related to changes in motor function following recovery from anesthesia and 2 days after ligation. The Pearson correlation coefficient was 0.980 and 0.923 for these two time points, respectively (P<0.001). In addition, the amplitude changes were positively related to pathological damage, with a Pearson correlation coefficient of 0.945 (P<0.001). The results of the present study suggested that amplitude changes in TceMEP are particularly sensitive to ischemia. Ischemia may be detected within 1 min and the amplitude changes begin to stabilize within 5 min following ligation of the lumbar artery. The use of intraoperative monitoring of TceMEP allows for the detection of spinal cord ischemic injury with no time delay, which may allow for protective measures to be taken to prevent the occurrence of irreversible spinal cord injury.

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“…Over the past 3 decades, various intraoperative strategies have been applied to protect the spinal cord and prevent such paraplegia with various levels of success, including left heart bypass, epidural cooling, 1 motor evoked potential monitoring, 2 and preoperative computed tomography (CT) angiography (CTA) and magnetic resonance angiography (MRA) to identify and preserve the artery of Adamkiewicz 3 and provide cerebrospinal fluid (CSF) drainage. 4,5 There is currently a class IB recommendation for CSF drainage for patients at high risk of SCI undergoing open DTAA or TAAA repair, according to the American College of Cardiology Foundation and American Heart Association guidelines, 6 and a class IB recommendation for CSF drain (CSFD) use in all patients according to the European Association for Cardiothoracic Surgery guidelines.…”

Section: Video Clip Is Available Onlinementioning

confidence: 99%

mentioning

confidence: 99%

Safety of perioperative cerebrospinal fluid drain as a protective strategy during descending and thoracoabdominal open aortic repair

et al. 2021

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Objective: We present our experience with routine application of the cerebrospinal fluid (CSF) drain (CSFD) during open aortic repair.Methods: We retrospectively reviewed 100 patients with descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) or who underwent CSFD insertion before open repair between 2006 and 2017. All CSFDs were inserted by the cardiovascular anesthesia team. The goal was to keep intracranial pressure<10 mm Hg during the surgical procedure by draining CSF at a rate of 20 to 30 mL/h. Postoperatively, CSFD was set to maintain the lumbar pressure <10 mm Hg to reduce the risk of postoperative paraplegia. CSFD was part of our standard cord protection regimen.Results: The mean patient age was 65.4 AE 11.7 years, and 60 (60%) were male. A CSFD was successfully inserted in all patients. The mean hospital length of stay was 11.9 AE 11.8 days, and hospital mortality was 6%. Postoperative transient paresis was observed in 4 patients (4%), and permanent paraplegia was seen in 2 (2%). CSFDrelated complications were reported in 14 patients (14%). Complications included persistent CSF leakage and blood-tinged CSF with and without intracranial hemorrhage and spinal cutaneous fistula in 7 (7%), 9 (9%), and 1 (1%), respectively. Longterm survival was excellent (68.4% at 10 years).Conclusions: CSFD is a safe practice when applied routinely as an adjunct strategy to prevent paraplegia in surgical management of DTAA and TAAA. We feel that this contributed to good early and late clinical results. (JTCVS Techniques 2021;6:1-8)Three-dimensional reconstruction of the anterior spinal artery (T12) using the dual-intensity Yale technique.

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Neuromonitoring Using Motor and Somatosensory Evoked Potentials in Aortic Surgery

Cited by 37 publications

References 21 publications

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Changes in transcranial electrical motor‑evoked potentials during the early and reversible stage of permanent spinal cord ischemia predict spinal cord injury in a rabbit animal model

Safety of perioperative cerebrospinal fluid drain as a protective strategy during descending and thoracoabdominal open aortic repair

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