Value and Pitfalls of Neurophysiological Monitoring in Thoracic and Thoracoabdominal Aortic Replacement and Endovascular Repair

Wolbeek, C ter; Hartert, Marc; Conzelmann, LO; Peivandi, AA; Czerny, Martin; Gottardi, Roman; Beyersdorf, Friedhelm; Weigang, Ernst

doi:10.1055/s-0030-1249904

Cited by 17 publications

(14 citation statements)

References 17 publications

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“…Neuro-electrophysiological monitoring can also be adversely influenced by anesthetic management [24,25], hypothermia [26], limb ischemia, and technological malfunctions (e.g., lead displacement, disconnection, etc.). “False negatives,” wherein patients have awakened with serious deficits in spite of normal evoked potentials, and “false positives,” wherein patients have awakened without deficits in spite of loss or degradation of signal, have both been reported with SSEP [27] and MEP [28,29] monitoring. Finally, accurate and timely interpretation of these data requires the continuous presence of a skilled physician with expertise in neuro-electrophysiological monitoring; such data are not easily interpretable by anesthesiologists, surgeons, neurointensivists, or nurses.…”

Section: Introductionmentioning

confidence: 99%

Optical Monitoring and Detection of Spinal Cord Ischemia

et al. 2013

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Spinal cord ischemia can lead to paralysis or paraparesis, but if detected early it may be amenable to treatment. Current methods use evoked potentials for detection of spinal cord ischemia, a decades old technology whose warning signs are indirect and significantly delayed from the onset of ischemia. Here we introduce and demonstrate a prototype fiber optic device that directly measures spinal cord blood flow and oxygenation. This technical advance in neurological monitoring promises a new standard of care for detection of spinal cord ischemia and the opportunity for early intervention. We demonstrate the probe in an adult Dorset sheep model. Both open and percutaneous approaches were evaluated during pharmacologic, physiological, and mechanical interventions designed to induce variations in spinal cord blood flow and oxygenation. The induced variations were rapidly and reproducibly detected, demonstrating direct measurement of spinal cord ischemia in real-time. In the future, this form of hemodynamic spinal cord diagnosis could significantly improve monitoring and management in a broad range of patients, including those undergoing thoracic and abdominal aortic revascularization, spine stabilization procedures for scoliosis and trauma, spinal cord tumor resection, and those requiring management of spinal cord injury in intensive care settings.

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Section: Introductionmentioning

confidence: 99%

Optical Monitoring and Detection of Spinal Cord Ischemia

et al. 2013

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“…Still, IONM is limited by insufficient data about potential problems and possible successful solutions as its accuracy measurement challenged by surgical procedure's adjustment, generating false positives [28,55,56]. Nevertheless, unrecovered SSEP had 97% chance of an ischemic perioperative insult; likely caused by hypoperfusion, tromboemboli, shunt malformation or inadequate BP control.…”

Section: Discussion Vascular Proceduresmentioning

confidence: 99%

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Marafona¹,

Machado²

2017

J Anesth Clin Res

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Background: Nowadays, intraoperative evoked potentials are recommended in a variety of procedures but there is still a lack of standard protocols and consensus about warning criteria. Moreover, studies are now being made to fundament its risk-beneficial ratio through recordings' predictive value for short and long term outcomes. Furthermore, wake up test limitations encouraged intraoperative evoked potentials research, a reliable monitoring technology.

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“…"False negatives," wherein patients awaken with important deficits in spite of "normal" evoked potentials, as well as "false positives," wherein patients awaken without deficits in spite of loss or degradation of signal, have been reported with both SSEP 12 and MEP 13 monitoring, even when used in a complimentary fashion. 14 Further, neuro-electrophysiological alerts may be temporally insensitive (delayed) relative to the inciting event, 15,16 which diminishes the chance for rescue of threatened tissue. To complicate the situation more, recovery of signals after rescue attempts is also markedly delayed, leaving the surgeon in a quandary per how to proceed.…”

Section: Introductionmentioning

confidence: 99%

Laser safety in fiber-optic monitoring of spinal cord hemodynamics: a preclinical evaluation

et al. 2018

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The prevention and treatment of spinal cord injury are focused upon the maintenance of spinal cord blood flow, yet no technology exists to monitor spinal cord ischemia. We recently demonstrated continuous monitoring of spinal cord ischemia with diffuse correlation and optical spectroscopies using an optical probe. Prior to clinical translation of this technology, it is critically important to demonstrate the safety profile of spinal cord exposure to the required light. To our knowledge, this is the first report of in situ safety testing of such a monitor. We expose the spinal cord to laser light utilizing a custom fiber-optic epidural probe in a survival surgery model (11 adult Dorset sheep). We compare the tissue illumination from our instrument with the American National Standards Institute maximum permissible exposures. We experimentally evaluate neurological and pathological outcomes of the irradiated sheep associated with prolonged exposure to the laser source and evaluate heating in ex vivo spinal cord samples. Spinal cord tissue was exposed to light levels at ∼18 × the maximum permissible exposure for the eye and ∼ ( 1 / 3 ) × for the skin. Multidisciplinary testing revealed no functional neurological sequelae, histopathologic evidence of laser-related injury to the spinal cord, or significant temperature changes in ex vivo samples. Low tissue irradiance and the lack of neurological, pathological, and temperature changes upon prolonged exposure to the laser source offer evidence that spinal cord tissues can be monitored safely with near-infrared optical probes placed within the epidural space.

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Value and Pitfalls of Neurophysiological Monitoring in Thoracic and Thoracoabdominal Aortic Replacement and Endovascular Repair

Cited by 17 publications

References 17 publications

Optical Monitoring and Detection of Spinal Cord Ischemia

Optical Monitoring and Detection of Spinal Cord Ischemia

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Laser safety in fiber-optic monitoring of spinal cord hemodynamics: a preclinical evaluation

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