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Monitoring Spinal Cord Function in Open and Endovascular Treatment of Thoracoabdominal Aortic Pathologies

  • Barend MeesEmail author
  • Geert Willem Schurink
  • Noud Peppelenbosch
  • Werner Mess
  • Michael Jacobs
Chapter

Abstract

Spinal cord ischemia is one of the most dreadful complications of thoracic and thoracoabdominal aortic surgery. The complex mechanisms of spinal cord perfusion under iatrogenic circumstances, such as surgery, are still not fully unraveled. Neuromonitoring during open and endovascular aortic surgery aims at assessing perioperative spinal cord function, allowing corrective measures in case of compromised spinal cord perfusion and thus reducing the incidence of postoperative spinal cord ischemia. The technique of motor evoked potentials is a reliable and highly accurate method to evaluate spinal cord integrity during thoracic and thoracoabdominal aortic repair.

Keywords

Spinal cord Neuromonitoring Motor evoked potentials Magnetic stimulation Somatosensory evoked potentials 

References

  1. 1.
    Melissano G, Bertoglio L, Rinaldi E, Leopardi M, Chiesa R. An anatomical review of spinal cord blood supply. J Cardiovasc Surg. 2015;56:699–706.Google Scholar
  2. 2.
    Melissano G, Civilini E, Bertoglio L, Calliari F, Campos Moraes Amato A, Chiesa R. Angio-CT imaging of the spinal cord vascularisation: a pictorial essay. Eur J Vasc Endovasc Surg. 2010;39:436–40.CrossRefGoogle Scholar
  3. 3.
    Etz CD, Kari FA, Mueller CS, Silovitz D, Brenner RM, Lin HM, et al. The collateral network concept: a reassessment of the anatomy of spinal cord perfusion. J Thorac Cardiovasc Surg. 2011;141:1020–8.CrossRefGoogle Scholar
  4. 4.
    Bosmia AN, Hogan E, Loukas M, Tubbs RS, Cohen-Gadol AA. Blood supply to the human spinal cord: part I. Anatomy and hemodynamics. Clin Anat. 2015;28:52–64.CrossRefGoogle Scholar
  5. 5.
    Bosmia AN, Tubbs RS, Hogan E, Bohnstedt BN, Denardo AJ, Loukas M, et al. Blood supply to the human spinal cord: part II. Imaging and pathology. Clin Anat. 2015;28:65–74.CrossRefGoogle Scholar
  6. 6.
    Nijenhuis RJ, Jacobs MJ, Jaspers K, Reinders M, van Engelshoven JM, Leiner T, et al. Comparison of magnetic resonance with computed tomography angiography for preoperative localization of the Adamkiewicz artery in thoracoabdominal aortic aneurysm patients. J Vasc Surg. 2007;45:677–85.CrossRefGoogle Scholar
  7. 7.
    Nijenhuis RJ, Jacobs MJ, Schurink GW, Kessels AG, van Engelshoven JM, Backes WH. Magnetic resonance angiography and neuromonitoring to assess spinal cord blood supply in thoracic and thoracoabdominal aortic aneurysm surgery. J Vasc Surg. 2007;45:71–7.CrossRefGoogle Scholar
  8. 8.
    Yamada N, Takamiya M, Kuribayashi S, Okita Y, Minatoya K, Tanaka R. MRA of the Adamkiewicz artery: a preoperative study for thoracic aortic aneurysm. J Comput Assist Tomogr. 2000;24:362–8.CrossRefGoogle Scholar
  9. 9.
    Yoshioka K, Niinuma H, Ohira A, Nasu K, Kawakami T, Sasaki M, et al. MR angiography and CT angiography of the artery of Adamkiewicz: noninvasive preoperative assessment of thoracoabdominal aortic aneurysm. Radiographics. 2003;23:1215–25.CrossRefGoogle Scholar
  10. 10.
    Jacobs MJ, de Mol BA, Elenbaas T, Mess WH, Kalkman CJ, Schurink GW, et al. Spinal cord blood supply in patients with thoracoabdominal aortic aneurysms. J Vasc Surg. 2002;35:30–7.CrossRefGoogle Scholar
  11. 11.
    Rothwell J, Burke D, Hicks R, Stephen J, Woodforth I, Crawford M. Transcranial electrical stimulation of the motor cortex in man: further evidence for the site of activation. J Physiol. 1994;481:243–50.CrossRefGoogle Scholar
  12. 12.
    Ubags LH, Kalkman CJ, Been HD. Influence of isoflurane on myogenic motor evoked potentials to single and multiple transcranial stimuli during nitrous oxide/opioid anesthesia. Neurosurgery. 1998;43:90–4.CrossRefGoogle Scholar
  13. 13.
    Ubags LH, Kalkman CJ, Been HD, Koelman JH, Ongerboer de Visser BW. A comparison of myogenic motor evoked responses to electrical and magnetic transcranial stimulation during nitrous oxide/opioid anesthesia. Anesth Analg. 1999;88:568–72.CrossRefGoogle Scholar
  14. 14.
    Achouh PE, Estrera AL, Miller CC 3rd, Azizzadeh A, Irani A, Wegryn TL, et al. Role of somatosensory evoked potentials in predicting outcome during thoracoabdominal aortic repair. Ann Thorac Surg. 2007;84:782–7.CrossRefGoogle Scholar
  15. 15.
    Shahin GM, Hamerlijnck RP, Schepens MA, Ter Beek HT, Vermeulen FE, Boezeman EH. Upper and lower extremity somatosensory evoked potential recording during surgery for aneurysms of the descending thoracic aorta. Eur J Cardiothorac Surg. 1996;10:299–304.CrossRefGoogle Scholar
  16. 16.
    Sloan TB, Jameson LC. Electrophysiologic monitoring during surgery to repair the thoraco-abdominal aorta. J Clin Neurophysiol. 2007;24:316–27.PubMedGoogle Scholar
  17. 17.
    Krauss WE. Vascular anatomy of the spinal cord. Neurosurg Clin N Am. 1999;10:9–15.CrossRefGoogle Scholar
  18. 18.
    Meylaerts SA, Jacobs MJ, van Iterson V, De Haan P, Kalkman CJ. Comparison of transcranial motor evoked potentials and somatosensory evoked potentials during thoracoabdominal aortic aneurysm repair. Ann Surg. 1999;230:742–9.CrossRefGoogle Scholar
  19. 19.
    Dong CC, MacDonald DB, Janusz MT. Intraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery. Ann Thorac Surg. 2002;74:S1873–6.CrossRefGoogle Scholar
  20. 20.
    van Dongen EP, Schepens MA, Morshuis WJ, ter Beek HT, Aarts LP, de Boer A, et al. Thoracic and thoracoabdominal aortic aneurysm repair: use of evoked potential monitoring in 118 patients. J Vasc Surg. 2001;34:1035–40.CrossRefGoogle Scholar
  21. 21.
    Keyhani K, Miller CC 3rd, Estrera AL, Wegryn T, Sheinbaum R, Safi HJ. Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2009;49:36–41.CrossRefGoogle Scholar
  22. 22.
    Greiner A, Mess WH, Schmidli J, Debus ES, Grommes J, Dick F, et al. Cyber medicine enables remote neuromonitoring during aortic surgery. J Vasc Surg. 2012;55:1227–32.CrossRefGoogle Scholar
  23. 23.
    See RB, Awosika OO, Cambria RP, Conrad MF, Lancaster RT, Patel VI, et al. Extended motor evoked potentials monitoring helps prevent delayed paraplegia after aortic surgery. Ann Neurol. 2016;79:636–45.CrossRefGoogle Scholar
  24. 24.
    Schurink GW, Nijenhuis RJ, Backes WH, Mess W, de Haan MW, Mochtar B, et al. Assessment of spinal cord circulation and function in endovascular treatment of thoracic aortic aneurysms. Ann Thorac Surg. 2007;83:S877–81.CrossRefGoogle Scholar
  25. 25.
    Weigang E, Hartert M, Siegenthaler MP, Pitzer-Hartert K, Luehr M, Sircar R, et al. Neurophysiological monitoring during thoracoabdominal aortic endovascular stent graft implantation. Eur J Cardiothorac Surg. 2006;29:392–6.CrossRefGoogle Scholar
  26. 26.
    Weigang E, Hartert M, Siegenthaler MP, Beckmann NA, Sircar R, Szabo G, et al. Perioperative management to improve neurologic outcome in thoracic or thoracoabdominal aortic stent-grafting. Ann Thorac Surg. 2006;82:1679–87.CrossRefGoogle Scholar
  27. 27.
    ter Wolbeek C, Hartert M, Conzelmann LO, Peivandi AA, Czerny M, Gottardi R, et al. Value and pitfalls of neurophysiological monitoring in thoracic and thoracoabdominal aortic replacement and endovascular repair. Thorac Cardiovasc Surg. 2010;58:260–4.CrossRefGoogle Scholar
  28. 28.
    Schurink GW, De Haan MW, Peppelenbosch AG, Mess W, Jacobs MJ. Spinal cord function monitoring during endovascular treatment of thoracoabdominal aneurysms: implications for staged procedures. J Cardiovasc Surg. 2013;54:S117–24.Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Barend Mees
    • 1
    Email author
  • Geert Willem Schurink
    • 1
  • Noud Peppelenbosch
    • 1
  • Werner Mess
    • 2
  • Michael Jacobs
    • 1
  1. 1.European Vascular Center Aachen-MaastrichtMaastricht University Medical Center+MaastrichtThe Netherlands
  2. 2.Department of Clinical NeurophysiologyMaastricht University Medical Center+MaastrichtThe Netherlands

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