Non-invasive spinal cord oxygenation monitoring: validating collateral network near-infrared spectroscopy for thoracoabdominal aortic aneurysm repair

Aspern, Konstantin von; Haunschild, Josephina; Hoyer, Alexandro; Luehr, Maximilian; Bakhtiary, Farhad; Misfeld, Martín; Mohr, Friedrich W.; Etz, Christian D.

doi:10.1093/ejcts/ezw063

Cited by 35 publications

(29 citation statements)

References 16 publications

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“…The second patient developed SCI, which was consistent with the reduction in the NIRS signal that did not recover after any intervention. Von Aspern et al 85 compared measurements of paravertebral muscle oxygenation using NIRS to direct measurements of the spinal cord oxygenation and microcirculatory flow by laser Doppler flowmetry in seven juvenile pigs. There was a significant positive correlation (r = 0.51 to 0.52; P < 0.001) between measurements of both devices and there was no significant difference between lumbar paraspinous muscle oxygenation and direct spinal cord oxygenation ( P = 0.30).…”

Section: Spinal Cord Monitoring During Tevarmentioning

confidence: 99%

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad

Ramadan

Sayed

et al. 2017

Can J Anesth/J Can Anesth

103

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Purpose Thoracic endovascular aortic aneurysm repair (TEVAR) has become a mainstay of therapy for aneurysmal and other disorders of the thoracic aorta. The purpose of this narrative review article is to summarize the current literature on the risk factors, pathophysiology of spinal cord injury (SCI) following TEVAR, and to discuss various intraoperative monitoring and treatment strategies. Source Articles considered in this review were identified through PubMed using the following search terms: thoracic aortic aneurysm, TEVAR, paralysis+TEVAR, risk factors+TEVAR, spinal cord ischemia+TEVAR, neuromonitoring+thoracic aortic aneurysm, spinal drain, cerebrospinal fluid drainage, treatment of spinal cord ischemia. Principal findings Spinal cord injury continues to be a challenging complication after TEVAR. Its incidence after TEVAR is not significantly reduced compared to open TAAA repair. However, compared to open procedures, delayed paralysis/paresis is the predominant presentation of SCI after TEVAR. The pathophysiology of SCI is complex and remains not fully understood though the evolving concept of the importance of the spinal cord’s collateral blood supply network and its imbalance after TEVAR is emerging as a leading factor in the development of SCI. Cerebrospinal fluid drainage, optimal blood pressure management, and newer surgical techniques are important components of the most current spinal cord protection strategies. Conclusion Further experimental and clinical research is needed to aid in the discovery of novel neuroprotective strategies for protection and treatment of SCI following TEVAR.

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Section: Spinal Cord Monitoring During Tevarmentioning

confidence: 99%

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad

Ramadan

Sayed

et al. 2017

Can J Anesth/J Can Anesth

103

View full text Add to dashboard Cite

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“…NIRS estimates mixed tissue hemoglobin oxygen saturation levels of the arterial, venous, and capillary blood within the field of view [10,11], which allows the oxygen supply-and-demand balance to be evaluated under differing conditions. Similar to what has been done with the cerebrum, several studies have measured spinal cord oxygenation using NIRS directly [12][13][14][15] (via surgical procedure or thin fiber-optic probe placed in the intrathecal or epidural space) or indirectly [16][17][18][19] (via paraspinal muscle oxygenation monitoring, based on the paraspinal collateral network concept) to monitor spinal cord perfusion, but few studies to date have assessed spinal cord autoregulation using this method.…”

Section: Introductionmentioning

confidence: 99%

Spinal cord autoregulation using near-infrared spectroscopy under normal, hypovolemic, and post-fluid resuscitation conditions in a swine model: a comparison with cerebral autoregulation

et al. 2020

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Background: Few studies have investigated spinal cord autoregulation using near-infrared spectroscopy (NIRS). Here, we assessed spinal cord autoregulation under normal, hypovolemic, and post-fluid resuscitation conditions compared with cerebral autoregulation. Methods: Ten pigs (36.1 ± 1.1 kg) were anesthetized with 2.5% isoflurane, before phenylephrine administration at 0.5, 1, 2, and 5 μg kg −1 min −1 in a stepwise fashion at 10-min intervals (baseline), followed by similar administration of sodium nitroprusside (SNP). Hypovolemia was induced by a 600-ml bleed (25% estimated total blood volume). Only phenylephrine was readministered (same protocol). Hypovolemia was reversed by infusing 600 ml hydroxyethyl starch, before readministering phenylephrine and SNP. The relationships between mean arterial pressure (MAP) and cerebral, thoracic, and lumbar spinal cord tissue oxygenation indices (TOIs) were evaluated. Results: Thoracic and lumbar spinal cord TOIs were approximately 15% and 10% lower, respectively, than the cerebral TOI at similar MAPs. The average relationship between MAP and each TOI showed an autoregulatory pattern, but negative correlations were observed in the cerebral TOI during phenylephrine infusion. A 600-ml bleed lowered each relationship < 5% and subsequent fluid resuscitation did not change the relationship. Individual oxygenation responses to blood pressure indicated that the spinal cord is more pressure-passive than the cerebrum. Paradoxical responses (an inverse relationship of tissue oxygenation to MAP) were observed particularly in cerebrum during phenylephrine infusion and were rare in the spinal cord.Conclusions: Spinal cord autoregulation is less robust than cerebral autoregulation and more pressure-dependent. Similar to cerebral oxygenation, spinal cord oxygenation is volume-tolerant but is more sensitive to hypotension.

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“…Aspern et al. 48 reported their measurements performed on pigs before and after aortic cross-clamping revealing a good correlation between cnNIRS and laser Doppler flowmetry, a proven method for direct oxygenation and flow assessment. The same group presented the feasibility of cnNIRS use in 20 patients prior, during and after open or endovascular thoracoabdominal repair.…”

Section: Near-infrared Spectroscopy Of the Collateral Networkmentioning

confidence: 98%

Strategies to prevent TEVAR-related spinal cord ischemia

et al. 2016

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Spinal cord ischemia remains the Achilles' heel of thoracic and thoracoabdominal diseases management. Great improvements in morbidity and mortality have been obtained with the endovascular approach TEVAR (Thoracic Endovascular Aortic Repair) but this devastating complication continues to severely affect the quality of life, even if the primary success of the procedure - dissection/aneurysm exclusion - has been achieved. Several strategies to deal with this complication have been published in the literature over the time. Knowledge and technology have been evolving from identification of the risk factors associated with spinal cord ischemia, including lessons learned from open surgery, and from developments in the collateral network concept for spinal cord perfusion. In this comprehensive review, the authors cover several topics from the traditional measures comprising haemodynamic control, cerebrospinal drainage and neuroprotective drugs, to the staged-procedures approach, the emerging MISACE (minimally invasive selective segmental artery coil-embolization) and innovative neurologic monitoring such as NIRS (near-infrared spectroscopy) of the collateral network.

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Non-invasive spinal cord oxygenation monitoring: validating collateral network near-infrared spectroscopy for thoracoabdominal aortic aneurysm repair

Cited by 35 publications

References 16 publications

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Spinal cord autoregulation using near-infrared spectroscopy under normal, hypovolemic, and post-fluid resuscitation conditions in a swine model: a comparison with cerebral autoregulation

Strategies to prevent TEVAR-related spinal cord ischemia

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