| Adjunctive therapy for spinal cord protection during thoracoabdominal aortic aneurysm repair. | |
| | |
MedLine Citation:
|
PMID: 9469776 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Paraplegia, resulting from spinal cord ischemia during thoracoabdominal aortic aneurysm (TAA) repair, continues to be a devastating complication. The incidence of neurological complications, including paraplegia and paraparesis following TAA repair, ranges from 4% to 32% and averages 13% for nondissecting TAA and higher for dissecting TAA. Our current understanding of spinal cord ischemia associated with TAA repair has evolved from animal research and clinical experience. The pathophysiology of spinal cord ischemia is intricately related to three physiological variables. These include the severity and duration of spinal cord ischemia, neuronal reperfusion after reestablishment of spinal cord blood flow, and the neuronal metabolic rate during the ischemic insult. We have developed a multimodality approach to the prevention of neurological deficits, during and after TAA repair, which includes minimizing the severity of spinal cord ischemia, reducing the anticipated reperfusion phenomenon, and lowering the spinal cord metabolic rate. Over the past 16 years, the senior author has undertaken surgical repair of 265 TAAs using a multimodality approach in the protection of spinal cord integrity. In our experience, a combination of adjunctive therapies is critical to minimize the ischemic interval, reduce the neuronal reperfusion injury, and decrease spinal cord metabolism. These techniques have evolved over time, resulting in an overall neurological deficit rate of 4.5% and a neurological deficit at the time of hospital discharge of 1.9%. This article will outline our multimodality approach for spinal cord protection during TAA repair. |
| | |
Authors:
|
I N Hamilton; L H Hollier |
Related Documents
:
|
6168336 - Cell groups in the lower brain stem of the rabbit projecting to the spinal cord, with s... 20559806 - Diagnosis of incomplete conduction block of spinal cord from skin surface using spinal ... 4049106 - Spinal cord monitoring. electrophysiological measures of sensory and motor function dur... 14756816 - Protein associated with myc (pam) is involved in spinal nociceptive processing. 15268916 - Regional brain response to faces of humans and dogs. 762256 - Variability of laminar patterns in the human lateral geniculate nucleus. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Seminars in thoracic and cardiovascular surgery Volume: 10 ISSN: 1043-0679 ISO Abbreviation: Semin. Thorac. Cardiovasc. Surg. Publication Date: 1998 Jan |
Date Detail:
|
Created Date: 1998-03-20 Completed Date: 1998-03-20 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 8917640 Medline TA: Semin Thorac Cardiovasc Surg Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 35-9 Citation Subset: IM |
Affiliation:
|
Department of Surgery, Chattanooga Unit of the College of Medicine, University of Tennessee 37403, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Animals Aortic Aneurysm, Abdominal / surgery* Aortic Aneurysm, Thoracic / surgery* Cerebrospinal Fluid Drainage Humans Intraoperative Care / methods Intraoperative Complications / prevention & control* Ischemia / prevention & control* Paraplegia / prevention & control Perfusion Reperfusion Injury / prevention & control Spinal Cord / blood supply*, metabolism |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Intraoperative adjuncts of spinal cord protection.
Next Document: Spinal cord protection in descending thoracic and thoracoabdominal aortic aneurysm repair.