Document Detail


Minimizing spinal cord injury during repair of descending thoracic and thoracoabdominal aneurysms: the Mount Sinai approach.
MedLine Citation:
PMID:  9469774     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In an effort to reduce the incidence of spinal cord injury following resection of descending thoracic and thoracoabdominal aneurysms, we have developed a multifaceted approach to maximize spinal cord perfusion which involves monitoring spinal cord function using somatosensory evoked potentials (SSEPs) intraoperatively and postoperatively. Intercostal and lumbar intersegmental vessels are sacrificed in a gradual stepwise fashion before the aneurysm is incised: none of these vessels is reattached unless SSEPs are abnormal following temporary occlusion, and this has not yet been observed. Postoperative spinal cord perfusion is maximized by keeping arterial pressure high and by draining cerebrospinal fluid if intrathecal pressure is elevated. Only two cases of permanent paraplegia have developed in 95 patients. Multivariate analysis showed extensive aneurysms (spanning 10 or more intersegmental arteries) and a history of smoking as the only significant risk factors for development of spinal cord injury.
Authors:
R B Griepp; M A Ergin; J D Galla; J J Klein; D Spielvogel; E B Griepp
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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:  25-8     Citation Subset:  IM    
Affiliation:
The Mount Sinai School of Medicine Department of Cardiothoracic Surgery, New York, NY 10029, USA.
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MeSH Terms
Descriptor/Qualifier:
Aortic Aneurysm, Abdominal / surgery*
Aortic Aneurysm, Thoracic / surgery*
Evoked Potentials, Somatosensory*
Humans
Intraoperative Complications / diagnosis*,  prevention & control
Ischemia / diagnosis*,  prevention & control
Monitoring, Intraoperative / methods*
Multivariate Analysis
Paraplegia / epidemiology,  prevention & control
Risk Factors
Smoking / epidemiology
Spinal Cord / blood supply*

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


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