Document Detail

The usefulness of the spinal and subcortical components of the posterior tibial nerve SEPs for spinal cord monitoring during aortic coarctation repair.
MedLine Citation:
PMID:  9146477     Owner:  NLM     Status:  MEDLINE    
This study examines how the recording of the lumbar and subcortical components of the posterior tibial nerve (PTN) SEPs may usefully replace that of cortical components in situations in which these components cannot be reliably obtained (infants, high concentrations of halogenated gasses). Lumbar, brain-stem, and cortical PTN SEPs were intraoperatively monitored in 7 patients undergoing repair of aortic coarctation under variable isoflurane concentration (up to 1.2%). Four patients were less than 1 year old. Two distinct activities were evidenced at the lumbar level in all of the patients: the dorsal root component (DRC) and the dorsal horn negativity (DHN). The equivalent of the adult P30 (lemniscal positivity; LP) was also present in all of the patients, whatever their age or the concentration of isoflurane. By contrast, the parietal activities were absent intraoperatively in the youngest patients. Spinal-cord ischemia consecutive to aortic cross-clamping gave rise to early DHN changes and later alterations of the LP in the two patients in which it occurred, while the DRC and the peripheral nerve activities remained unchanged. This elective sensitivity of the DHN is likely due to it being dependent on the gray matter of the spinal cord, the basal metabolism of which is greater than that of the white matter and to the situation of the DHN generator in a watershed zone of the spinal cord. This study emphasizes the interest of PTN SEPs for spinal-cord monitoring in vascular surgery and the importance of combining the recording of parietal activities with that of the lumbar spinal components.
J M Guérit; C Witdoeckt; J Rubay; A Matta; R Dion
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Electroencephalography and clinical neurophysiology     Volume:  104     ISSN:  0013-4694     ISO Abbreviation:  Electroencephalogr Clin Neurophysiol     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-06-05     Completed Date:  1997-06-05     Revised Date:  2008-09-09    
Medline Journal Info:
Nlm Unique ID:  0375035     Medline TA:  Electroencephalogr Clin Neurophysiol     Country:  IRELAND    
Other Details:
Languages:  eng     Pagination:  115-21     Citation Subset:  IM    
Cliniques Universitaires Saint-Luc, University of Louvain Medical School, Brussels, Belgium.
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MeSH Terms
Aortic Coarctation / surgery*
Child, Preschool
Evoked Potentials, Somatosensory / physiology*
Monitoring, Intraoperative*
Spinal Cord / physiopathology*
Tibial Nerve / physiopathology*

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