Thorac Cardiovasc Surg 2005; 53(2): 69-73
DOI: 10.1055/s-2004-830521
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Improved Spinal Cord Perfusion during Thoracoabdominal Aortic Repair[1]

E. Weigang1 , M. Hartert1 , P. von Samson1 , U. Pechstein2 , J. Genstorfer1 , K. Pitzer1 , J. Zentner2 , F. Beyersdorf1
  • 1Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany
  • 2Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
Further Information

Publication History

Received March 3, 2004

Publication Date:
23 March 2005 (online)

Abstract

Objectives: The study's aim is to evaluate whether intraoperative neurophysiological monitoring with transcranial motor-evoked potentials (tcMEP) permits early recognition of neuronal lesions, thus making interventions to prevent irreversible spinal cord damage possible. Material and Methods: TcMEP monitoring was carried out in twelve patients (mean age 60 years) during open surgical thoracoabdominal aortic replacement. Current approaches for corrective, spinal cord-protecting interventions consist of: raising distal perfusion by increasing cardiopulmonary bypass (CPB) flow, catecholamine application, reducing central venous pressure, reimplantation of segmental arteries, and cerebrospinal fluid (CSF) drainage. Results: Nine patients exhibited loss of tcMEP after segmental aorta clamping. In five patients we observed a recovery of tcMEP through counteractive measures. Three patients died intraoperatively, one patient presented with postoperative paraplegia and loss of tcMEP. Conclusion: TcMEP loss is associated with spinal cord ischaemia, causing postoperative paraplegia. TcMEP monitoring is an excellent method to detect spinal cord ischaemia at an early stage.

1 Presented at the Fourth Joint Meeting of The German, Austrian, and Swiss Society for Thoracic and Cardiovascular Surgery, Hamburg, Germany, February 15 - 18, 2004

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1 Presented at the Fourth Joint Meeting of The German, Austrian, and Swiss Society for Thoracic and Cardiovascular Surgery, Hamburg, Germany, February 15 - 18, 2004

MD Ernst Weigang

Department of Cardiovascular Surgery
University Hospital Freiburg, Germany

Hugstetter Straße 55

79106 Freiburg

Germany

Email: weigang@ch11.ukl.uni-freiburg.de