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Electrophysiological Monitoring During Thoracic Aortic Aneurysm Surgery

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Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

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Abstract

Intraoperative monitoring (IOM) of the central nervous system during surgery to repair aneurysms of the thoracoabdominal aorta (TAA) is an area of significant inquiry due to the substantial incidence of neurological injury with surgery. The incidence of paralysis varies with the surgical, interventional, or hybrid procedure used. It is clear that the risk of perioperative paralysis also varies due to a substantial number of nonsurgical factors, including changes in the vascular perfusion resulting from surgery, the specific patient anatomy, and patient comorbidities. This chapter will review the surgical techniques and the IOM techniques utilized.

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References

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  1. Crawford ES, Crawford JL, Safi HJ, Coselli JS, Hess KR, Brooks B, et al. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg. 1986;3(3):389–404.

    Article  CAS  PubMed  Google Scholar 

  2. *Connolly JE. Hume Memorial lecture. Prevention of spinal cord complications in aortic surgery. Am J Surg. 1998;176(2):92–101.

    Google Scholar 

  3. *Goldfinger JZ, Halperin JL, Marin ML, Stewart AS, Eagle KA, Fuster V. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol. 2014;64(16):1725–39.

    Google Scholar 

  4. Jones TH, Morawetz RB, Crowell RM, Marcoux FW, FitzGibbon SJ, DeGirolami U, et al. Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg. 1981;54(6):773–82.

    Article  CAS  PubMed  Google Scholar 

  5. Hickey R, Sloan TB, Rogers JN. Functional organization and physiology of the spinal cord. In: Porter SS, editor. Anesthesia for surgery of the spine. New York: McGraw-Hill; 1995. p. 15–39.

    Google Scholar 

  6. Drummond JC. The lower limit of autoregulation: time to revise our thinking? Anesthesiology. 1997;86(6):1431–3.

    Article  CAS  PubMed  Google Scholar 

  7. Djindjian R, Hurth M, Houdart R. Arterial supply of the spinal cord. In: Djindjian R, editor. Angiography of the spinal cord. Baltimore: University Park Press; 1970. p. 3–13.

    Google Scholar 

  8. *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(1):30–7.

    Google Scholar 

  9. Jacobs MJ, Elenbaas TW, Schurink GWH, Mess WH, Mochtar B. Assessment of spinal cord integrity during thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2002;74(5):S1864–6; discussion S92–8.

    Article  PubMed  Google Scholar 

  10. Adams HD, Van Geertruyden HH. Neurologic complications of aortic surgery. Ann Surg. 1956;144:574–610.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kuniyoshi Y, Koja K, Miyagi K, Shimoji M, Uezu T, Arakaki K, et al. Prevention of postoperative paraplegia during thoracoabdominal aortic surgery. Ann Thorac Surg. 2003;76(5):1477–84.

    Article  PubMed  Google Scholar 

  12. Ogino H, Sasaki H, Minatoya K, Matsuda H, Yamada N, Kitamura S, et al. Combined use of adamkiewicz artery demonstration and motor-evoked potentials in descending and thoracoabdominal repair. Ann Thorac Surg. 2006;82(2):592–6.

    Article  PubMed  Google Scholar 

  13. 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(6):1035–40.

    Article  PubMed  Google Scholar 

  14. Wan IY, Angelini GD, Bryan AJ, Ryder I, Underwood MJ. Prevention of spinal cord ischaemia during descending thoracic and thoracoabdominal aortic surgery. Eur J Cardiothorac Surg. 2001;19(2):203–13.

    Article  CAS  PubMed  Google Scholar 

  15. *Ziganshin BA, Elefteriades JA. Surgical management of thoracoabdominal aneurysms. Heart. 2014;100(20):1577–82.

    Google Scholar 

  16. *Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Jr, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27–129.

    Google Scholar 

  17. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385(9970):800–11.

    Article  PubMed  Google Scholar 

  18. Elefteriades JA, Farkas EA. Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. J Am Coll Cardiol. 2010;55(9):841–57.

    Article  CAS  PubMed  Google Scholar 

  19. Gloviczki P. Surgical repair of thoracoabdominal aneurysms: patient selection, techniques and results. Cardiovasc Surg. 2002;10(4):434–41.

    Article  PubMed  Google Scholar 

  20. *de Haan P, Kalkman CJ. Spinal cord monitoring: somatosensory- and motor-evoked potentials. Anesthesiol Clin North Am. 2001;19(4):923–45.

    Google Scholar 

  21. *Dong CC, MacDonald DB, Janusz MT, Dong CCJ, MacDonald DB, Janusz MT. Intraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery. Ann Thorac Surg. 2002;74(5):S1873–6; discussion S92–8.

    Google Scholar 

  22. Pillai JB, Pellet Y, Panagopoulos G, Sadek MA, Abjigitova D, Weiss D, et al. Somatosensory-evoked potential-guided intercostal artery reimplantation in thoracoabdominal aortic aneurysm surgery. Innovations (Phila). 2013;8(4):302–6.

    Article  Google Scholar 

  23. Svensson LG, Hess KR, Coselli JS, Safi HJ. Influence of segmental arteries, extent, and atriofemoral bypass on postoperative paraplegia after thoracoabdominal aortic operations. J Vasc Surg. 1994;20(2):255–62.

    Article  CAS  PubMed  Google Scholar 

  24. Jacobs MJ, Meylaerts SA, de Haan P, de Mol BA, Kalkman CJ. Assessment of spinal cord ischemia by means of evoked potential monitoring during thoracoabdominal aortic surgery. Semin Vasc Surg. 2000;13(4):299–307.

    CAS  PubMed  Google Scholar 

  25. Jacobs MJ, Meylaerts SA, de Haan P, de Mol BA, Kalkman CJ. Strategies to prevent neurologic deficit based on motor-evoked potentials in type I and II thoracoabdominal aortic aneurysm repair. J Vasc Surg. 1999;29(1):48–57; discussion 57–9.

    Article  CAS  PubMed  Google Scholar 

  26. Shimizu H, Mori A, Yoshitake A, Yamada T, Morisaki H, Okano H, et al. Thoracic and thoracoabdominal aortic repair under regional spinal cord hypothermia. Eur J Cardiothorac Surg. 2014;46(1):40–3.

    Article  PubMed  Google Scholar 

  27. Augoustides JG, Stone ME, Drenger B. Novel approaches to spinal cord protection during thoracoabdominal aortic interventions. Curr Opin Anaesthesiol. 2014;27(1):98–105.

    Article  PubMed  Google Scholar 

  28. Cunningham Jr JN, Laschinger JC, Merkin HA, Nathan IM, Colvin S, Ransohoff J, et al. Measurement of spinal cord ischemia during operations upon the thoracic aorta: initial clinical experience. Ann Surg. 1982;196(3):285–96.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Robertazzi RR, Cunningham Jr JN. Monitoring of somatosensory evoked potentials: a primer on the intraoperative detection of spinal cord ischemia during aortic reconstructive surgery. Semin Thorac Cardiovasc Surg. 1998;10(1):11–7.

    Article  CAS  PubMed  Google Scholar 

  30. Laschinger JC, Cunningham Jr JN, Isom OW, Nathan IM, Spencer FC. Definition of the safe lower limits of aortic resection during surgical procedures on the thoracoabdominal aorta: use of somatosensory evoked potentials. J Am Coll Cardiol. 1983;2(5):959–65.

    Article  CAS  PubMed  Google Scholar 

  31. Laschinger JC, Cunningham Jr JN, Catinella FP, Nathan IM, Knopp EA, Spencer FC. Detection and prevention of intraoperative spinal cord ischemia after cross-clamping of the thoracic aorta: use of somatosensory evoked potentials. Surgery. 1982;92(6):1109–17.

    CAS  PubMed  Google Scholar 

  32. *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(6):742–9.

    Google Scholar 

  33. Elmore JR, Gloviczki P, Harper Jr CM, Murray MJ, Wu QH, Bower TC, et al. Spinal cord injury in experimental thoracic aortic occlusion: investigation of combined methods of protection. J Vasc Surg. 1992;15(5):789–98; discussion 98–9.

    Article  CAS  PubMed  Google Scholar 

  34. Laschinger JC, Cunningham Jr JN, Baumann FG, Cooper MM, Krieger KH, Spencer FC. Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. III. Intraoperative identification of vessels critical to spinal cord blood supply. J Thorac Cardiovasc Surg. 1987;94(2):271–4.

    CAS  PubMed  Google Scholar 

  35. Cunningham JN, Lim KH, Rose DM. Use of somatosensory evoked potentials to monitor spinal cord ischemia during surgery on the thoracic and thoraco-abdominal aorta. In: Ducker TBBR, editor. Neurophysiology and standards of spinal cord monitoring. New York: Springer; 1998. p. 328–40.

    Google Scholar 

  36. Reuter DG, Tacker Jr WA, Badylak SF, Voorhees III WD, Konrad PE. Correlation of motor-evoked potential response to ischemic spinal cord damage. J Thorac Cardiovasc Surg. 1992;104(2):262–72.

    CAS  PubMed  Google Scholar 

  37. Crawford ES, Svensson LG, Hess KR, Shenaq SS, Coselli JS, Safi HJ, et al. A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg. 1991;13(1):36–45; discussion 45–6.

    Article  CAS  PubMed  Google Scholar 

  38. de Haan P, Kalkman CJ, de Mol BA, Ubags LH, Veldman DJ, Jacobs MJ. Efficacy of transcranial motor-evoked myogenic potentials to detect spinal cord ischemia during operations for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg. 1997;113(1):87–100; discussion 100–1.

    Article  PubMed  Google Scholar 

  39. de Haan P, Kalkman CJ, Jacobs MJ. Spinal cord monitoring with myogenic motor evoked potentials: early detection of spinal cord ischemia as an integral part of spinal cord protective strategies during thoracoabdominal aneurysm surgery. Semin Thorac Cardiovasc Surg. 1998;10(1):19–24.

    Article  PubMed  Google Scholar 

  40. 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 Cardiothoracic Surg. 2006;29(3):392–6.

    Article  Google Scholar 

  41. Weigang E, Hartert M, Sircar R, V Samson P, Pitzer K, Genstorfer J, et al. Setup of neurophysiological monitoring with tcMEP/SSEP during thoracoabdominal aneurysm repair. Thorac Cardiovasc Surg. 2005;53(1):28–32.

    Article  CAS  PubMed  Google Scholar 

  42. Kobrine AI, Evans DE, Rizzoli HV. The effects of ischemia on long-tract neural conduction in the spinal cord. J Neurosurg. 1979;50(5):639–44.

    Article  CAS  PubMed  Google Scholar 

  43. Guerit JM, Verhelst R, Rubay J, Khoury G, Matta A, Dion R. Multilevel somatosensory evoked potentials (SEPs) for spinal cord monitoring in descending thoracic and thoraco-abdominal aortic surgery. Eur J Cardiothorac Surg. 1996;10(2):93–103; discussion 103–4.

    Article  CAS  PubMed  Google Scholar 

  44. Sala F, Lanteri P, Bricolo A, Sala F, Lanteri P, Bricolo A. Motor evoked potential monitoring for spinal cord and brain stem surgery. Adv Tech Stand Neurosurg. 2004;29:133–69.

    Article  CAS  PubMed  Google Scholar 

  45. 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(5):1227–32; discussion 32–3.

    Article  PubMed  Google Scholar 

  46. Greenberg RK, Lytle B. Endovascular repair of thoracoabdominal aneurysms. Circulation. 2008;117(17):2288–96.

    Article  PubMed  Google Scholar 

  47. Uchida N. How to prevent spinal cord injury during endovascular repair of thoracic aortic disease. Gen Thorac Cardiovasc Surg. 2014;62(7):391–7.

    Article  PubMed  Google Scholar 

  48. Abraha I, Romagnoli C, Montedori A, Cirocchi R. Thoracic stent graft versus surgery for thoracic aneurysm. Cochrane Database Syst Rev. 2009;1:1–12.

    Google Scholar 

  49. Canaud L, Ozdemir BA, Patterson BO, Holt PJ, Loftus IM, Thompson MM. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg. 2014;260(2):389–95.

    Article  PubMed  Google Scholar 

  50. Bicknell CD, Riga CV, Wolfe JHN. Prevention of paraplegia during thoracoabdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2009;37(6):654–60.

    Article  CAS  PubMed  Google Scholar 

  51. Sinha AC, Cheung AT. Spinal cord protection and thoracic aortic surgery. Curr Opin Anaesthesiol. 2010;23(1):95–102.

    Article  PubMed  Google Scholar 

  52. Schurink GWH, 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(2):S877–81; discussion S90–2.

    Article  PubMed  Google Scholar 

  53. Mitchell RS, Miller DC, Dake MD, Semba CP, Moore KA, Sakai T. Thoracic aortic aneurysm repair with an endovascular stent graft: the “first generation”. Ann Thorac Surg. 1999;67(6):1971–4; discussion 9–80.

    Article  CAS  PubMed  Google Scholar 

  54. Bafort C, Astarci P, Goffette P, El Khoury G, Guerit J-M, de Tourtchaninoff M, et al. Predicting spinal cord ischemia before endovascular thoracoabdominal aneurysm repair: monitoring somatosensory evoked potentials. J Endovasc Ther. 2002;9(3):289–94.

    Article  PubMed  Google Scholar 

  55. Ishimaru S, Kawaguchi S, Koizumi N, Obitsu Y, Ishikawa M. Preliminary report on prediction of spinal cord ischemia in endovascular stent graft repair of thoracic aortic aneurysm by retrievable stent graft. J Thorac Cardiovasc Surg. 1998;115(4):811–8.

    Article  CAS  PubMed  Google Scholar 

  56. Maeda T, Yoshitani K, Sato S, Matsuda H, Inatomi Y, Tomita Y, et al. Spinal cord ischemia after endovascular aortic repair versus open surgical repair for descending thoracic and thoracoabdominal aortic aneurism. J Anesth. 2012;26(6):805–11.

    Article  PubMed  Google Scholar 

  57. Gkremoutis A, Schmandra T, Meyn M, Schmitz-Rixen T, Keese M. Hybrid approach to emergent and urgent treatment of complex thoracoabdominal aortic pathology. Eur J Vasc Endovasc Surg. 2014;48(4):407–13.

    Article  CAS  PubMed  Google Scholar 

  58. Zhang Y, Lu Q, Pei Y, Wu M, Zhang S, Hong Y, et al. Total endovascular repair of thoracoabdominal aortic aneurysms with non-customized stent grafts. Ann Thorac Surg. 2014;98(5):1606–12.

    Article  PubMed  Google Scholar 

  59. Czermak BV, Fraedrich G, Perkmann R, Mallouhi A, Steingruber IE, Waldenberger P, et al. Endovascular repair of thoracic aortic disease: what we have learned. Curr Probl Diagn Radiol. 2004;33(6):269–82.

    Article  PubMed  Google Scholar 

  60. Cunningham Jr JN, Laschinger JC, Spencer FC. Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. IV. Clinical observations and results. J Thorac Cardiovasc Surg. 1987;94(2):275–85.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA

    Tod B. Sloan M.D., M.B.A., Ph.D., Leslie C. Jameson M.D. & Claudia F. Clavijo M.D.

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  1. Tod B. Sloan M.D., M.B.A., Ph.D.
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  2. Leslie C. Jameson M.D.
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  3. Claudia F. Clavijo M.D.
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Correspondence to Tod B. Sloan M.D., M.B.A., Ph.D. .

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Editors and Affiliations

  1. Departments of Anesthesiology, Neurological Surgery and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Antoun Koht

  2. Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA

    Tod B. Sloan

  3. Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA

    J. Richard Toleikis

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Sloan, T.B., Jameson, L.C., Clavijo, C.F. (2017). Electrophysiological Monitoring During Thoracic Aortic Aneurysm Surgery. In: Koht, A., Sloan, T., Toleikis, J. (eds) Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals. Springer, Cham. https://doi.org/10.1007/978-3-319-46542-5_40

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  • DOI: https://doi.org/10.1007/978-3-319-46542-5_40

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