Spinal Cord Protection Strategies



Spinal cord protection and preservation during and after reconstruction of the descending thoracic aorta (DTA) is clinically important because spinal cord injury is still common in high-risk groups and it significantly worsens perioperative mortality and morbidity.13 There is a diverse set of aortic pathologies that may require reconstruction of the DTA (refer to Table 11.1 for their description and classification). Aortic repair for each of these pathologies carries a risk of spinal cord ischemia (SCI) that may present intraoperatively or postoperatively. In the contemporary era, there are three established options for reconstruction of the DTA – surgical repair (SR), thoracic endovascular aortic repair (TEVAR), and hybrid repair (involving both SR and TEVAR). The type of DTA repair is important to understand as it may significantly influence the risk for SCI. The specific details of these aortic repair techniques are covered elsewhere in this textbook.


Spinal Cord Motor Evoke Potential Spinal Cord Ischemia Deep Hypothermic Circulatory Arrest Lower Extremity Weakness 
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  1. 1.
    Greenberg RK, Lu Q, Roselli E, et al. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation. 2008;118:808–817.PubMedGoogle Scholar
  2. 2.
    Svensson LG. Paralysis after aortic surgery: in search of lost cord function. Surgeon. 2005;3:396–405.PubMedGoogle Scholar
  3. 3.
    Dillavou ED, Makaroun MS. Predictors of morbidity and mortality with endovascular and open thoracic aneurysm repair. J Vasc Surg. 2008;48:1114–1120.PubMedGoogle Scholar
  4. 4.
    Estrera AL, Rubenstein FS, Miller CC, et al. Descending thoracic aortic aneurysm: surgical approach and treatment using the adjuncts cerebrospinal fluid drainage and distal aortic perfusion. Ann Thorac Surg. 2005;72:481–486.Google Scholar
  5. 5.
    Golledge J, Eagle KA. Acute aortic dissection. Lancet. 2008;372:55–65.PubMedGoogle Scholar
  6. 6.
    Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2007;83:S862–S864.PubMedGoogle Scholar
  7. 7.
    Svensson LG, Kouchoukos NT, Miller DC, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent grafts. Ann Thorac Surg. 2008;85:S1–S41.PubMedGoogle Scholar
  8. 8.
    Makaroun MS, Dillavou ED, Kee ST, et al. Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORETAG thoracic endoprosthesis. J Vasc Surg. 2005;41:1–9.PubMedGoogle Scholar
  9. 9.
    Szeto WY, Bavaria JE, Bowen FW, et al. The hybrid aortic arch repair: brachiocephalic bypass and concomitant endovascular aortic arch stent graft placement. J Card Surg. 2007;22:97–102.PubMedGoogle Scholar
  10. 10.
    Woo EY, Bavaria JE, Pochettino A, et al. Techniques for preserving vertebral artery perfusion during thoracic aortic stent grafting requiring aortic arch landing. Vasc Endovasc Surg. 2006;40:367–373.Google Scholar
  11. 11.
    Drenth DJ, Verhoeven EL, Prins TR, et al. Relocation of supra-aortic vessels to facilitate endovascular treatment of a ruptured aortic arch aneurysm. J Thorac Cardiovasc Surg. 2003;126:1184–1185.PubMedGoogle Scholar
  12. 12.
    Pantin EJ, Cheung A. Thoracic aorta. In: Kaplan JA, Reich DL, Lake CL, Konstadt SN, eds. Kaplan’s Cardiac Anesthesia. 5th ed. Philadelphia: Saunders Elsevier; 2006:723–764.Google Scholar
  13. 13.
    Cambria RP, Clouse WD, Davison JK, et al. Thoracoabdminal aneurysm repair: results with 337 operations performed over a 15-year interval. Ann Surg. 2002;236:471–479.PubMedGoogle Scholar
  14. 14.
    Gutsche JT, Cheung AT, McGarvey ML, et al. Risk factors for perioperative stroke after thoracic endovascular repair. Ann Thorac Surg. 2007;84:1195–2000.PubMedGoogle Scholar
  15. 15.
    Freezor RJ, Martin TD, Hess PJ, et al. Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR). J Endovasc Ther. 2007;14:568–573.Google Scholar
  16. 16.
    Wong DR, Coselli JS, Amerman K, et al. Delayed spinal cord deficits after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2007;83:1345–1355.PubMedGoogle Scholar
  17. 17.
    Cheung AT, Weiss SJ, McGarvey ML, et al. Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction. Ann Thorac Surg. 2002;74:413–419.PubMedGoogle Scholar
  18. 18.
    Hughes GC, Daneshmand MA, Swaminathan M, et al. ‘Real world’ thoracic endografting: results with the Gore TAG device 2 years after U.S. FDA approval. Ann Thorac Surg. 2008;86:1530–1538.PubMedGoogle Scholar
  19. 19.
    Estrera AL, Miller CC III, Chen EP, et al. Descending thoracic aortic aneurysm repair: 12-year experience using distal aortic perfusion and cerebrospinal fluid drainage. Ann Thorac Surg. 2005;80:1290–1296.PubMedGoogle Scholar
  20. 20.
    Coselli JS, LeMaire SA, Conklin LD, et al. Left heart bypass during descending thoracic aortic aneurysm repair does not reduce the incidence of paraplegia. Ann Thorac Surg. 2004;77:1298–1303.PubMedGoogle Scholar
  21. 21.
    Borst HG, Jurmann m, Buhner B, et al. Risk of replacement of descending aorta with a standardized left heart bypass technique. J Thorac Cardiovasc Surg. 1994;107:126–133.PubMedGoogle Scholar
  22. 22.
    Svensson LG, Crawford ES, Hess KR, et al. Variables predictive of outcome in 832 patients undergoing repairs of the descending thoracic aorta. Chest. 1993;104:1248–1253.PubMedGoogle Scholar
  23. 23.
    Verdant A. Descending thoracic aortic aneurysms: surgical treatment with the Gott shunt. Can J Surg. 1992;35:493–496.PubMedGoogle Scholar
  24. 24.
    Kouchoukos NT, Masetti P, Rokkas CK, et al. Safety and efficacy of hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending and thoracoabdominal aorta. Ann Thorac Surg. 2001;72:699–707.PubMedGoogle Scholar
  25. 25.
    Fehrenbacher JW, Hart DW, Huddleston E, et al. Optimal end-organ protection for thoracic and thoracoabdominal aortic aneurysm repair using deep hypothermic circulatory arrest. Ann Thorac Surg. 2007;83:1041–1046.PubMedGoogle Scholar
  26. 26.
    Kieffer E, Chiche L, Cluzel P, et al. Open surgical repair of descending thoracic aortic aneurysms in the endovascular era: a 9-year single-center study. Ann Vasc Surg. 2009;23:60–66.Google Scholar
  27. 27.
    Misfeld M, Sievers HH, Hadlak M, et al. Rate of paraplegia and mortality in elective descending and thoracoabdominal aortic repair in the modern surgical era. Thorac Cardiovasc Surg. 2008;56:342–347.PubMedGoogle Scholar
  28. 28.
    Kieffer E, Chiche L, Godet G, et al. Type IV thoracoabdominal aneurysm repair: predictors of postoperative mortality, spinal cord injury, and acute intestinal ischemia. Ann Vasc Surg. 2008;22:822–828.PubMedGoogle Scholar
  29. 29.
    Gutsche JT, Szeto W, Cheung AT. Endovascular stenting of thoracic aortic aneurysm. Anesthesiol Clin. 2008;26:481–499.PubMedGoogle Scholar
  30. 30.
    Dake MD, Miller DC, Mitchell RS, et al. The “first generation” of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg. 1998;116:689–703.PubMedGoogle Scholar
  31. 31.
    Gravereaux EC, Faries PL, Burks JA, et al. Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms. J Vasc Surg. 2001;34:997–1003.PubMedGoogle Scholar
  32. 32.
    Bell RE, Taylor PR, Aukett M, et al. Mid-term results for second-generation thoracic stent grafts. Br J Surg. 2003;90:811–817.PubMedGoogle Scholar
  33. 33.
    Orend KH, Scharrer-Pamler R, Kapfer X, et al. Endovascular treatment in diseases of the descending thoracic aorta: 6-year results of a single center. J Vasc Surg. 2003;37:91–99.PubMedGoogle Scholar
  34. 34.
    Bortone AS, De Cillis E, D’Agostino D, et al. Endovascular treatment of thoracic aortic disease: four years of experience. Circulation. 2004;110:II262–II267.PubMedGoogle Scholar
  35. 35.
    Hansen CJ, Bui H, Donayre CE, et al. Complications of endovascular repair of high-risk and emergent descending thoracic aortic aneurysms and dissections. J Vasc Surg. 2004;40:228–234.PubMedGoogle Scholar
  36. 36.
    Leurs LJ, Bell R, Degrieck Y, et al. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg. 2004;40:670–679.PubMedGoogle Scholar
  37. 37.
    Chiesa R, Melissano G, Marrocco-Trischitta MM, et al. Spinal cord ischemia after elective stent-graft repair of the thoracic aorta. J Vasc Surg. 2005;42:11–17.PubMedGoogle Scholar
  38. 38.
    Greenberg RK, O’Neill S, Walker E, et al. Endovascular repair of thoracic aortic lesions with the Zenith TX1 and TX2 thoracic grafts: intermediate-term results. J Vasc Surg. 2005;41:589–596.PubMedGoogle Scholar
  39. 39.
    Cheung AT, Pochettino A, McGarvey ML, et al. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms. Ann Thorac Surg. 2005;80:1280–1288.PubMedGoogle Scholar
  40. 40.
    Stone DH, Brewster DC, Kwolek CJ, et al. Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. J Vasc Surg. 2006;44:1188–1197.PubMedGoogle Scholar
  41. 41.
    Iyer VS, Mackenzie KS, Tse LW, et al. Early outcomes after elective and emergent endovascular repair of the thoracic aorta. J Vasc Surg. 2006;43:677–683.PubMedGoogle Scholar
  42. 42.
    Khoynezhad A, Donayre CE, Bui H, et al. Risk factors of neurologic deficit after thoracic aortic endografting. Ann Thorac Surg. 2007;83:S882–S889.PubMedGoogle Scholar
  43. 43.
    Rodriguez JA, Olsen DM, Shtutman A, et al. Application of endograft to treat thoracic aortic pathologies: a single center experience. J Vasc Surg. 2007;46:413–420.PubMedGoogle Scholar
  44. 44.
    Zipfel B, Hammerschmidt R, Krabatsch T, et al. Stent-grafting of the thoracic aorta by the cardiothoracic surgeon. Ann Thorac Surg. 2007;83:441–448.PubMedGoogle Scholar
  45. 45.
    Hnath JC, Mehta M, Taggert JB, et al. Strategies to improve spinal cord ischemia in endovascular thoracic aortic repair: outcomes of a prospective cerebrospinal fluid drainage protocol. J Vasc Surg. 2008;48:836–840.PubMedGoogle Scholar
  46. 46.
    Amabile P, Grisoli D, Giorgi R, et al. Incidence and determinants of spinal cord ischemia in stent-graft repair of the thoracic aorta. Eur J Vasc Endovasc Surg. 2008;35:455–461.PubMedGoogle Scholar
  47. 47.
    Parker JD, Golledge J. Outcome of endovascular treatment of acute type B dissection. Ann Thorac Surg. 2008;86:1707–1712.PubMedGoogle Scholar
  48. 48.
    Walsh SR, Tang TY, Sadat U, et al. Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results. J Vasc Surg. 2008;47:1094–1098.PubMedGoogle Scholar
  49. 49.
    Tang GL, Tehrani HY, Usman A, et al. Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: a modern meta-analysis. J Vasc Surg. 2008;47:671–675.PubMedGoogle Scholar
  50. 50.
    Hoffer EK, Forauer AR, Silas AM, et al. Endovascular stent-graft or open surgical repair for blunt thoracic aortic trauma: systematic review. J Vasc Interv Radiol. 2008;19:1153–1164.PubMedGoogle Scholar
  51. 51.
    Xenos ES, Abedi NN, Davenport DL, et al. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg. 2008;48:1342–1351.Google Scholar
  52. 52.
    Akowuah E, Angelini G, Bryan AJ. Open versus endovascular repair of traumatic aortic rupture: a systematic review. J Thorac Cardiovasc Surg. 2009;138:768–769.Google Scholar
  53. 53.
    Jacobs MJ, Mommertz G, Koeppel TA, et al. Surgical repair of thoracoabdominal aortic aneurysms. J Cardiovas Surg (Torino). 2007;48:49–58.Google Scholar
  54. 54.
    Griepp RB, Griepp EB. Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept. Ann Thorac Surg. 2007;83:S865–S869.PubMedGoogle Scholar
  55. 55.
    Adamkiewicz A. Die blutegefasse des menschlichen ruckenmarkes. Sitzungsberichte Akademie der Wissen Schaften in Wein – Mathematische-Naturwissen Schaftliche Klasse – Abteilun. 1882;84:101–130.Google Scholar
  56. 56.
    Lazorthes G, Gouaze A, Zadeh JO, et al. Arterial vascularization of the spinal cord: recent studies of the anatomic substitution pathways. J Neurosurg. 1971;35:253–262.Google Scholar
  57. 57.
    Nojiri J, Matsumoto K, Kato A, et al. The Adamkiewicz artery: demonstration by intra-arterial computed tomographic angiography. Eur J Cardiothorac Surg. 2007;31:249–255.PubMedGoogle Scholar
  58. 58.
    Boll DT, Bulow H, Blackham KA, et al. MDCT angiography of the spinal vasculature and the artery of Adamkiewicz. AJR Am J Roentgenol. 2006;187:1054–1060.PubMedGoogle Scholar
  59. 59.
    Backes WH, Nijenhuis RJ, Mess WH, et al. Magnetic resonance angiography of collateral blood supply to spinal cord in thoracic and thoracoabdominal aortic aneurysm patients. J Vasc Surg. 2008;48:261–271.PubMedGoogle Scholar
  60. 60.
    Felix I, Schlosser MD, Mojibian H, et al. Open thoracic or thoracoabdominal aortic aneurysm repair after previous abdominal aortic aneurysm surgery. J Vasc Surg. 2008;48:761–768.Google Scholar
  61. 61.
    Svensson LG, Hess KR, Coselli JS, et al. Influence of segmental arteries, extent and atriofemoral bypass on postoperative paraplegia after thoracoabdominal aortic operations. J Vasc Surg. 1994;20:255–262.PubMedGoogle Scholar
  62. 62.
    Kawanishi Y, Okada K, Matsumori M, et al. Influence of perioperative hemodynamics on spinal cord ischemia in thoracoabdominal aortic repair. Ann Thorac Surg. 2007;84:488–492.PubMedGoogle Scholar
  63. 63.
    Etz CD, Luehr M, Kari FA, et al. Paraplegia after extensive thoracic and thoracoabdominal aortic aneurysm repair: does critical spinal cord ischemia occur postoperatively? J Thorac Cardiovasc Surg. 2008;135:324–330.PubMedGoogle Scholar
  64. 64.
    Augoustides JG. Management of spinal cord perfusion pressure to minimize intermediate-delayed paraplegia: critical role of central venous pressure. J Thorac Cardiovasc Surg. 2008;136:796.PubMedGoogle Scholar
  65. 65.
    Augoustides JG. Venous function and pressure: what is their role in the management of spinal cord ischemia after thoracoabdominal aortic aneurysm repair? Anesthesiology. 2008;109:933.PubMedGoogle Scholar
  66. 66.
    Cernalanu AC, Olah A, Cilley JH Jr, et al. Effect of sodium nitroprusside on paraplegia during cross-clamping of the thoracic aorta. Ann Thorac Surg. 1993;56:1035–1037.Google Scholar
  67. 67.
    Simpson JI, Eide TR, Schiff GA, et al. Isoflurane versus sodium nitroprusside for the control of proximal hypertension during thoracic aortic cross-clamping: effects on spinal cord ischemia. J Cardiothorac Vasc Anesth. 1995;9:491–496.PubMedGoogle Scholar
  68. 68.
    Griepp RB, Ergin MA, Galla JD, et al. Looking for the artery of Adamkiewicz: a quest to minimize paraplegia after operations for aneurysms of the descending thoracic and thoracoabdominal aorta. J Thorac Cardiovasc Surg. 1996;112:1202–1213.PubMedGoogle Scholar
  69. 69.
    Mac Arthur RG, Carter SA, Coselli JS, et al. Organ protection during thoracoabdominal aortic surgery: rationale for a multimodality approach. Semin Cardiothorac Vasc Anesth. 2005;9:143–149.Google Scholar
  70. 70.
    Coselli JS, LeMaire SA. Left heart bypass reduces paraplegia rates after thoracoabdominal aneurysm repair. Ann Thorac Surg. 1999;67:1931–1934.PubMedGoogle Scholar
  71. 71.
    Safi HJ, Campbell MP, Miller CC 3rd, et al. Cerebrospinal fluid drainage and distal aortic perfusion decrease the incidence of neurological deficit: the results of 343 descending and thoracoabdominal aortic aneurysm repairs. Eur J Vasc Endovasc Surg. 1997;14:118–124.PubMedGoogle Scholar
  72. 72.
    Crestanello JA, Zehr KJ, Mullany CJ, et al. The effect of adjuvant perfusion techniques on the incidence of paraplegia after repair of traumatic thoracic aortic transections. Mayo Clin Proc. 2006;81:625–630.PubMedGoogle Scholar
  73. 73.
    Feezor RJ, Martin TD, Hess PJ Jr, et al. Extent of aortic coverage and incidence of spinal cord ischemia after thoracic endovascular aneurysm repair. Ann Thorac Surg. 2008;86:1809–1814.PubMedGoogle Scholar
  74. 74.
    Christiansson L, Ulus AT, Heelberg A, et al. Aspects of the spinal cord circulation as assessed by intrathecal oxygen tension monitoring during various arterial interruptions in the pig. J Thorac Cardiovasc Surg. 2001;121:762–772.PubMedGoogle Scholar
  75. 75.
    Acher CW, Wynn MM. How we do it. Cardiovasc Surg. 1999;7:593–596.PubMedGoogle Scholar
  76. 76.
    Etz CD, Halstead JC, Spilvogel D, et al. Thoracic and thoracoabdominal aneurysm repair: is reimplantation of the spinal arteries a waste of time? Ann Thorac Surg. 2006;82:1670–1677.PubMedGoogle Scholar
  77. 77.
    Woo EY, McGarvey M, Jackson BM, et al. Spinal cord ischemia may be reduced via a novel technique of intercostal artery revascularization during open thoracoabdominal aneurysm repair. J Vasc Surg. 2007;46:421–426.PubMedGoogle Scholar
  78. 78.
    Parmer SS, Carpenter JP, Stavropoulos SW, et al. Endoleaks after endovascular repair of thoracic aortic aneurysms. J Vasc Surg. 2006;44:447–452.PubMedGoogle Scholar
  79. 79.
    Morales JP, Greenberg RK, Lu Q, et al. Endoleaks following endovascular repair of thoracic aortic aneurysm: etiology and outcomes. J Endovasc Ther. 2008;15:631–638.PubMedGoogle Scholar
  80. 80.
    Gorlitzer M, Mertikian G, Trnka H, et al. Translumbar treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysm. Interact Cardiovasc Thorac Surg. 2008;7:781–784.PubMedGoogle Scholar
  81. 81.
    Blaisdell FW, Cooley DA. The mechanism of paraplegia and its relationship to spinal fluid pressure. Surgery. 1962;51:351–355.PubMedGoogle Scholar
  82. 82.
    Hill AB, Kalman PG, Johnston KW, et al. Reversal of delayed-onset paraplegia after thoracic aortic surgery with cerebrospinal fluid drainage. J Vasc Surg. 1994;20:315–317.PubMedGoogle Scholar
  83. 83.
    Ling E, Arellano R. Systematic overview of the evidence supporting the use of cerebrospinal fluid drainage in thoracoabdominal aneurysm surgery for prevention of paraplegia. Anesthesiology. 2000;93:1115–1122.PubMedGoogle Scholar
  84. 84.
    Khan SN, Stansby G. Cerebrospinal fluid drainage for thoracic and thoracoabdominal aortic aneurysm surgery. Cochrane Database Syst Rev. 2004;1:CD003635Google Scholar
  85. 85.
    Cina CS, Abouzahr L, Arena GO, et al. Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aneurysm surgery: a systematic review and meta-analysis. J Vasc Surg. 2004;40:36–44.PubMedGoogle Scholar
  86. 86.
    Cheung AT, Pochettino A, Guvakov DV, et al. Safety of lumbar drains in thoracic aortic operations performed with extracorporeal circulation. Ann Thorac Surg. 2003;76:1190–1196.PubMedGoogle Scholar
  87. 87.
    Dardik A, Perler BA, Roseborough GS, et al. Subdural hematoma after thoracoabdominal aortic aneurysm repair: an underreported complication of spinal fluid drainage. J Vasc Surg. 2002;36:47–50.PubMedGoogle Scholar
  88. 88.
    Subramaniam B, Panzica PJ, Pawlowski JB, et al. Epidural blood patch for acute subdural hematoma after spinal catheter drainage during hybrid thoracoabdominal aneurysm repair. J Cardiothorac Vasc Anesth. 2007;21:704–708.PubMedGoogle Scholar
  89. 89.
    Coplin WM, Avelling AM, Kim DK, et al. Bacterial meningitis associated with lumbar drains: a retrospective cohort study. J Neurol Neurosurg Psychiatry. 1999;67:468–473.PubMedGoogle Scholar
  90. 90.
    Sethi M, Grigore Am, Davison JK. Pro: it is safe to proceed with thoracoabdominal aneurysm surgery after encountering a bloody tap during cerebrospinal fluid catheter placement. J Cardiothorac Vasc Anesth. 2006;20:269–272.PubMedGoogle Scholar
  91. 91.
    Wynn MM, Mittnacht A, Norris E. Con: surgery should not proceed when a bloody tap occurs during spinal drain placement for elective thoracoabdominal aortic surgery. J Cardiothorac Vasc Anesth. 2006;20:273–275.PubMedGoogle Scholar
  92. 92.
    McGarvey ML, Mullen MT, Woo EY, et al. The treatment of spinal cord ischemia following thoracic endovascular aortic repair. Neurocrit Care. 2007;6:35–39.PubMedGoogle Scholar
  93. 93.
    Strauch JT, Lauten A, Spielvogel D, et al. Mild hypothermia protects the spinal cord from ischemic injury in a chronic porcine model. Eur J Cardiothorac Surg. 2004;25:708–715.PubMedGoogle Scholar
  94. 94.
    Cambria RP, Davison JK, Carter C, et al. Epidural cooling for spinal cord protection during thoracoabdominal aneurysm repair: a five year experience.J Vasc Surg. 2000;31:1093–1102.PubMedGoogle Scholar
  95. 95.
    Motoyoshi N, Takahashi G, Sakurai M, et al. Safety and efficacy of epidural cooling for regional spinal cord hypothermia during thoracoabdominal aneurysm repair. Eur J Cardiothorac Surg. 2004;25:139–141.PubMedGoogle Scholar
  96. 96.
    Tabayashi K, Motoyoshi N, Saiki Y, et al. Efficacy of perfusion of the epidural space and cerebrospinal fluid drainage during repair of extent I and extent II thoracoabdominal aneurysm. J Cardiovas Surg (Torino). 2008;49:749–755.Google Scholar
  97. 97.
    Moomiale RM, Ransden J, Stein J, et al. Cooling catheter for spinal cord preservation in thoracic aortic surgery. J Cardiovas Surg (Torino). 2007;48:103–108.Google Scholar
  98. 98.
    Yoshitake A, Mori A, Shimizu H, et al. Use of an epidural cooling catheter with a closed countercurrent lumen to protect against ischemic spinal cord injury in pigs. J Thorac Cardiovasc Surg. 2007;134:1220–1226.PubMedGoogle Scholar
  99. 99.
    Pocar M, Rossi V, Addis A, et al. Spinal cord retrograde perfusion: review of the literature and experimental observations. J Card Surg. 2007;22:124–128.PubMedGoogle Scholar
  100. 100.
    Juvonen T, Biancari F. Spinal cord protection by retrograde venous perfusion during descending thoracic and thoracoabdominal aortic surgery: fact or fiction? Scan Cardiovasc J. 2002;36:4–5.Google Scholar
  101. 101.
    Juvonen T, Biancari F, Rimpilainen J, et al. Strategies for spinal cord protection during descending thoracic and thoracoabdominal aortic surgery: up-to-date experimental and clinical results. Scan Cardiovasc J. 2002;36:136–160.Google Scholar
  102. 102.
    Tabayashi K. Spinal cord protection during thoracoabdominal aneurysm repair. Surg Today. 2005;35:1–6.PubMedGoogle Scholar
  103. 103.
    Kohno H, Ishida A, Imamaki M, et al. Efficacy and vasodilatory benefits of magnesium prophylaxis for protection against spinal cord ischemia. Ann Vasc Surg. 2007;21:352–359.PubMedGoogle Scholar
  104. 104.
    Hamaishi M, Orihashi K, Isaka M, et al. Low-dose edaravone injection into the clamped aorta prevents ischemic spinal cord injury. Ann Vasc Surg. 2009;23:128–135.Google Scholar
  105. 105.
    Sirlak M, Eryilmaz S, Inan M, et al. Effects of carbamazepine on spinal cord ischemia. J Thorac Cardiovasc Surg. 2008;136:1038–1043.PubMedGoogle Scholar
  106. 106.
    Laschinger JC, Cunningham JN, Cooper MM, et al. Prevention of ischemic spinal cord injury following aortic cross-clamping: use of corticosteroids. Ann Thorac Surg. 1984;38:500–507.PubMedGoogle Scholar
  107. 107.
    Bracken MB, Shepard MJ, Collins WF, et al. A randomized trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury: results of the second national acute spinal cord injury study. N Engl J Med. 1990;3322:1405–1411.Google Scholar
  108. 108.
    Lee JS, Hong JM, Kim YJ. Ischaemic preconditioning to prevent lethal ischemic spinal cord injury in a swine model. J Invest Surg. 2008;21:209–214.PubMedGoogle Scholar
  109. 109.
    Benicio A, Moreira LF, Monaco BA, et al. Comparative study between ischemic preconditioning and cerebrospinal fluid drainage as methods of spinal cord protection in dogs. Rev Bras Cir Cardiovasc. 2007;22:15–23.PubMedGoogle Scholar
  110. 110.
    Monaco BA, Benicio A, Contreras IS, et al. Ischemic preconditioning and spinal cord function monitoring in the descending thoracic aorta approach. Arq Bras Cardiol. 2007;88(33):262–266.Google Scholar
  111. 111.
    Contreras IS, Moreira LF, Ballester G, et al. Immediate ischemic preconditioning based on somatosensory evoked potentials seems to prevent spinal cord injury following descending thoracic aorta cross-clamping. Eur J Cardiothorac Surg. 2005;28:274–279.PubMedGoogle Scholar
  112. 112.
    Selimoglu O, Ugurlucan M, Basaran M, et al. Efficacy of remote ischaemic preconditioning for spinal cord protection against ischaemic injury: association with heat shock protein expression. Folia Neuropathol. 2008;46:204–212.PubMedGoogle Scholar
  113. 113.
    Sloan TB, Jameson LC. Electrophysiologic monitoring during surgery to repair the thoracoabdominal aorta. J Clin Neurophysiol. 2007;24:316–327.PubMedGoogle Scholar
  114. 114.
    Galla JD, Ergin MA, Lansman SL, et al. Use of somatosensory evoked potentials for thoracic and thoracoabdominal aortic resections. Ann Thorac Surg. 1999;67:1947–1952.PubMedGoogle Scholar
  115. 115.
    Guerit JM, Witdoeckt C, Verhelst R, et al. Sensitivity, specificity, and surgical impact of somatosensory evoked potentials in descending aorta surgery. Ann Thorac Surg. 1999;67:1943–1946.PubMedGoogle Scholar
  116. 116.
    Weigang E, Hartert M, Siegenthaler MP, et al. Neurophysiological monitoring during thoracoabdominal aortic endovascular stent graft implantation. Eur J Cardiothorac Surg. 2006;29:392–396.PubMedGoogle Scholar
  117. 117.
    Jacobs MJ, Elenbaas TW, Schurink GW, et al. Assessment of spinal cord integrity during thoracoabdominal aneurysm repair. Ann Thorac Surg. 2002;74:S1864–S1866.PubMedGoogle Scholar
  118. 118.
    Shine TSJ, Harrison B, De Ruyter ML, et al. Motor and somatosensory evoked potentials: their role in predicting spinal cord ischemia in patients undergoing thoracoabdominal aortic aneurysm repair with regional lumbar epidural cooling. Anesthesiology. 2008;108:580–587.PubMedGoogle Scholar
  119. 119.
    Keyhani K, Miller III CC, Estrera AL, et al. Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2009;49:36–41.Google Scholar
  120. 120.
    Messe SR, Bavaria JE, Mullen M, et al. Neurologic outcomes from high risk descending thoracic and thoracoabdominal aortic operations in the era of endovascular repair. Neurocrit Care. 2008;9:344–351.PubMedGoogle Scholar
  121. 121.
    Biglioni P, Roberto M, Cannata, et al. Upper lower spinal cord blood supply: The continuity of the anterior spinal artery and the relevance of the lumber arteries. J Thorac Cardiovasc Surg. 2004;127(4): 1188–92.Google Scholar

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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical CareUniversity of Pennsylvania Medical CenterPhiladelphiaUSA

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