| Influence of preservation or perfusion of intraoperatively identified spinal cord blood supply on spinal motor evoked potentials and paraplegia after aortic surgery. | |
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MedLine Citation:
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PMID: 1999854 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Permanent ligation of arteries supplying blood to the spinal cord in operations for aortic aneurysm can lead to spinal cord ischemia, which can result in either paraparesis or paraplegia. This report describes a rapid method of intraoperative identification of those arteries that supply the spinal cord by use of an intrathecal platinum electrode to detect hydrogen in solution that has been injected into the aortic ostia. Preservation or perfusion of those identified arteries supplying the spinal cord may decrease the rate of postoperative neurologic complications. Of 28 porcine experiments with postoperative observation for 24 hours, there were 3 initial pilot experiments in which saline saturated with hydrogen was injected into the temporarily cross-clamped aorta. Twenty animals were then randomized to (1) preservation of only the vessels sequentially identified to supply blood to the spinal cord from T-13 to L-5 (n = 10); (2) division of the vessels supplying the spinal cord (n = 10). A further five animals underwent perfusion experiments wherein the identified cord arteries were perfused by a shunt, the other nonsupply arteries were divided, and the aorta was kept clamped for 45 minutes. Spinal motor evoked potentials were elicited with an intrathecal electrode and were highly sensitive for paralysis. Paralysis occurred in 0/3 pilot (p less than 0.013 vs division); 8/10 division; 1/10 preservation (p less than 0.0017 vs division); and perfusion 1/5 (p less than 0.025 vs division). Results of a pilot study in eight humans shows that the technique can be used to rapidly identify segmental arteries supplying the spinal cord, to determine if distal perfusion is supplying the spinal cord with blood flow, and if reattached segmental arteries are patent. |
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Authors:
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L G Svensson; V Patel; M F Robinson; T Ueda; J O Roehm; E S Crawford |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of vascular surgery Volume: 13 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 1991 Mar |
Date Detail:
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Created Date: 1991-04-10 Completed Date: 1991-04-10 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 355-65 Citation Subset: IM |
Affiliation:
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Department of Surgery, Baylor College of Medicine, Houston, TX 77030. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Animals Aorta, Abdominal / surgery Aorta, Thoracic / surgery Aortic Aneurysm / surgery* Electrodes, Implanted Evoked Potentials / physiology Female Humans Hydrogen / diagnostic use Intraoperative Care / methods Male Middle Aged Paraplegia / prevention & control* Postoperative Complications / prevention & control* Sodium Chloride / diagnostic use Spinal Cord / blood supply*, physiology |
| Chemical | |
Reg. No./Substance:
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1333-74-0/Hydrogen; 7647-14-5/Sodium Chloride |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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