Document Detail


Intraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery.
MedLine Citation:
PMID:  12440684     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Postoperative paraplegia is one of the most dreaded complications after descending thoracic and thoracoabdominal aneurysm surgery. In this study, intraoperative monitoring was applied during resection of descending thoracic and thoracoabdominal aneurysms to detect spinal cord ischemia and help prevent paraplegia. METHODS: Fifty-six patients (descending thoracic, 25; thoracoabdominal, 31) were monitored intraoperatively with both motor- (MEP) and somatosensory- (SSEP) evoked potentials. MEPs were elicited with transcranial electrical stimulation and recorded from the spinal epidural space (D wave) or peripheral muscles (myogenic MEP). SSEPs were obtained with median and tibial nerve stimulation. RESULTS: A total of 16 patients (28.6%) showed MEP evidence of spinal cord ischemia, only 4 of whom had delayed congruent SSEP changes. In 13 patients (23.2%), ischemic changes in MEPs were reversed by reimplanting segmental arteries or increasing blood flow or blood pressure. None of these 13 patients suffered acute paraplegia regardless of the status of SSEP at the end of the procedure, but 1 of them developed delayed postoperative paraplegia after multisystem failure. Three patients (5.4%) who had persistent loss of MEPs despite of recovery of SSEPs awoke paraplegic. CONCLUSIONS: The results demonstrate that compared with SSEP, MEP, especially myogenic MEP, is more sensitive and specific in detection of spinal cord ischemia, and that intraoperative monitoring can indeed help prevent paraplegia.
Authors:
Charles C J Dong; David B MacDonald; Michael T Janusz
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  74     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-11-20     Completed Date:  2002-12-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S1873-6; discussion S1892-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Vancouver General Hospital, BC, Canada. cdong@interchg.ubc.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aneurysm, Dissecting / physiopathology,  surgery*
Aortic Aneurysm, Abdominal / physiopathology,  surgery*
Aortic Aneurysm, Thoracic / physiopathology,  surgery*
Evoked Potentials, Motor / physiology
Evoked Potentials, Somatosensory / physiology
Female
Humans
Intraoperative Complications / physiopathology,  prevention & control*
Male
Middle Aged
Monitoring, Intraoperative*
Neurologic Examination
Paraplegia / physiopathology,  prevention & control
Postoperative Complications / physiopathology,  prevention & control
Predictive Value of Tests
Risk Factors
Spinal Cord / physiopathology
Spinal Cord Ischemia / physiopathology,  prevention & control*

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


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