Document Detail

Comparison of transcranial motor evoked potentials and somatosensory evoked potentials during thoracoabdominal aortic aneurysm repair.
MedLine Citation:
PMID:  10615928     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare transcranial motor evoked potentials (tc-MEPs) and somatosensory evoked potentials (SSEPs) as indicators of spinal cord function during thoracoabdominal aortic aneurysm repair. SUMMARY BACKGROUND DATA: Somatosensory evoked potentials reflect conduction in dorsal columns. tc-MEPs represent anterior horn motor neuron function. This is the first study to compare the techniques directly during thoracoabdominal aortic aneurysm repair. METHODS: In 38 patients, thoracoabdominal aortic aneurysm repair (type I, n = 10, type II, n = 14, type III, n = 6, type IV, n = 8) was performed using left heart bypass and segmental artery reimplantation. tc-MEP amplitudes <25% and SSEP amplitudes <50% and/or latencies >110% were considered indicators of cord ischemia. The authors compared the response of both methods to interventions and correlated the responses at the end of surgery to neurologic outcomes. RESULTS: Ischemic tc-MEP changes occurred in 18/38 patients and could be restored by segmental artery reperfusion (n = 12) or by increasing blood pressure (n = 6). Significant SSEP changes accompanied these tc-MEP events in only 5/18 patients, with a delay of 2 to 34 minutes. SSEPs recovered in only two patients. In another 11 patients, SSEP amplitudes fell progressively to <50% of control without parallel tc-MEP changes or association with cross-clamp events or pressure decreases. At the end of the procedure, tc-MEP amplitudes were 84 +/- 46% of control. In contrast, SSEP amplitudes were <50% of control in 15 patients (39%). No paraplegia occurred. CONCLUSION: In all patients, tc-MEP events could be corrected by applying protective strategies. No patient awoke paraplegic. SSEPs showed delayed ischemia detection and a high rate of false-positive results.
S A Meylaerts; M J Jacobs; V van Iterson; P De Haan; C J Kalkman
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  230     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1999 Dec 
Date Detail:
Created Date:  2000-01-20     Completed Date:  2000-01-20     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  742-9     Citation Subset:  AIM; IM    
Department of Vascular Surgery, Academic Medical Center of the University of Amsterdam, The Netherlands.
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MeSH Terms
Aortic Aneurysm, Abdominal / physiopathology*,  surgery*
Aortic Aneurysm, Thoracic / physiopathology*,  surgery*
Evoked Potentials, Motor*
Evoked Potentials, Somatosensory*
Middle Aged
Prospective Studies
Spinal Cord / physiopathology*
Spinal Cord Ischemia / physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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