Advertisement

Ischaemic Spinal Cord Injury Following Thoracoabdominal Aneurysm Surgery

  • P. de Haan
  • J. Kesecioglu
Conference paper

Abstract

Thoracoabdominal or descending thoracic aneurysm surgery carries the risk of ischaemic spinal cord injury. Since the appearance of thoracoabdominal reconstructions in the early 1950’s, the risk of paraplegia or paraparesis was soon recognized as a complication of these procedures. The paradigm for paraplegia causation, the interruption of the de-segmented blood supply to the anterior spinal artery, was established by Adams [1]. The extent of the aneurysm was found to be a significant predictor of spinal cord injury. Crawford classified thoracoabdominal aortic aneurysms (TAAA) as follows: type I involves the descending thoracic and upper abdominal aorta; type II includes the entire descending aorta and the abdominal aorta below the renal arteries, and is the most extensive; type III includes less then half of the descending thoracic aorta and most of the abdominal aorta; and type IV involves most or all of the abdominal aorta [2]. In 1 509 patients who had undergone repair for the treatment of thoracoabdominal aortic disease, Svensson found that type I, II, III, and IV aneurysms were associated with lower extremity neurological deficit rates of 15%, 31%, 7%, and 4% respectively [3]. The incidence of overall neurological deficits in that series was 16 %. In another large series of patients, which were equally distributed between types I to IV aneurysms, the long-term survivors (30 days) had a 4.4 % incidence of paraplegia and a 5% incidence of paraparesis [2]. In contrast, after elective abdominal aortic aneurysms surgery the incidence of lower extremity neurological deficits was 0.16–0.25 % [4, 5]. Repair of aneurysms confined to the descending thoracic aorta resulted in paraplegia in 6.5 % of the patients [6]. Despite recent advances in the treatment of thoracoabdominal aneurysms, postoperative paraparesis or paraplegia re- mains a distinct possibility after an otherwise successful operation. Variables predictive of neurologic deficits of the lower extremities include aortic clamp time, the presence of rupture or dissection, the extent of aneurysm, a history of smoking, postoperative hypotension, and age [2, 3, 7, 8].

Keywords

Thoracoabdominal Aortic Aneurysm Spinal Cord Blood Flow Thoracoabdominal Aneurysm Left Heart Bypass Aortic Crossclamping 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Adams HD, Geertruyden H (1956) Neurologic complications of aortic surgery. Ann Surg 144: 574–610PubMedCrossRefGoogle Scholar
  2. 2.
    Crawford ES, Crawford JL, Safi HJ et al (1986) Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg 3: 389–404PubMedCrossRefGoogle Scholar
  3. 3.
    Svensson LG, Crawford ES, Hess KR et al (1993) Experience with 1 509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 17: 357–368PubMedCrossRefGoogle Scholar
  4. 4.
    Joseph MG, Langsfeld MA, Lusby RJ (1989) Infrarenal aortic aneurysm: unusual cause of paraparesis. Aust N Z J Surg 59: 743–744PubMedCrossRefGoogle Scholar
  5. 5.
    Noirhomme P, Buche M, Louagie Y et al (1991) Ischemic complications of abdominal aortic surgery. J Cardiovasc Surg (Torino) 32: 451–455Google Scholar
  6. 6.
    Livesay JJ, Cooley DA, Ventemiglia RA et al (1985) Surgical experience in descending thoracic aneurysmectomy with and without adjuncts to avoid ischemia. Ann Thorac Surg 39: 37–46PubMedCrossRefGoogle Scholar
  7. 7.
    Griepp RB, Ergin MA, Galla JD et al (1996) 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 112: 1202–1213PubMedCrossRefGoogle Scholar
  8. 8.
    Crawford ES, Svensson LG, Hess KR et al (1990) A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg 13: 36–45CrossRefGoogle Scholar
  9. 9.
    Katz NM, Blackstone EH, Kirklin JW et al (1981) Incremental risk factors for spinal cord injury following operation for acute traumatic aortic transection. J Thorac Cardiovasc Surg 81: 669–674PubMedGoogle Scholar
  10. 10.
    Svensson LG, Hess KR, Coselli JS et al (1994) Influence of segmental arteries, extent, and atriofemoral bypass on postoperative paraplegia after thoracoabdominal aortic operations. J Vasc Surg 20: 255–262PubMedCrossRefGoogle Scholar
  11. 11.
    Grabitz K, Sandmann W, Stuhmeier K et al (1996) The risk of ischemic spinal cord injury in patients undergoing graft replacement for thoracoabdominal aortic aneurysms. J Vasc Surg 23: 230–240PubMedCrossRefGoogle Scholar
  12. 12.
    Safi HJ, Hess KR, Randel M et al (1996) Cerebrospinal fluid drainage and distal aortic perfusion — reducing neurologic complications in repair of thoracoabdominal aortic aneurysm types I and II J Vasc Surg 23: 223–228PubMedCrossRefGoogle Scholar
  13. 13.
    Cooley DA, Baldwin RT (1992) Technique of open distal anastomosis fo repair of descending thoracic aortic aneurysms. Ann Thorac Surg 54: 932–936PubMedCrossRefGoogle Scholar
  14. 14.
    Scheinin SA, Cooley DA (1994) Graft replacement of the descending thoracic aorta: results of “open” distal anastomosis. Ann Thorac Surg 58: 19–22PubMedCrossRefGoogle Scholar
  15. 15.
    Crawford ES, Walker Hd, Saleh SA et al (1981) Graft replacement of aneurysm in descending thoracic aorta: results without bypass or shunting. Surgery 89: 73–85PubMedGoogle Scholar
  16. 16.
    Gott VL (1972) Heparinized shunts for thoracic vascular operations. Ann Thorac Surg 14: 219–222PubMedCrossRefGoogle Scholar
  17. 17.
    Verdant A, Cossette R, Pagé A et al (1995) Aneurysms of the descending thoracic aorta: Three hundred sixty-six consecutive cases resected without paraplegia. J Vasc Surg 21: 385–391PubMedCrossRefGoogle Scholar
  18. 18.
    Molina JE, Cogordan J, Einzig S et al (1985) Adequacy of ascending aorta-descending aorta shunt during cross-clamping of the thoracic aorta for prevention of spinal cord injury. J Thorac Cardiovasc Surg 90: 126–136PubMedGoogle Scholar
  19. 19.
    Kaplan DK, Atsumi N, D’Ambra MN et al (1995) Distal circulatory support for thoracic aortic operations: effects on intracranial pressure. Ann Thorac Surg 59: 448–452PubMedCrossRefGoogle Scholar
  20. 20.
    Connolly J, Wakabayashi A, German J et al (1971) Clinical experience with pulsatile left heart bypass without anticoagulation for thoracic aneurysms. J Thor Cardiovasc Surg 62Google Scholar
  21. 21.
    Borst HG, Jurmann M, Buhner B et al (1994) Risk of replacement of descending aorta with a standardized left heart bypass technique. J Thorac Cardiovasc Surg 107: 126–132PubMedGoogle Scholar
  22. 22.
    Jacobs MJ, de Mol BA, Legemate DA et al (1997) Retrograde aortic and selective organ perfusion during thoracoabdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 14: 360–366PubMedCrossRefGoogle Scholar
  23. 23.
    de Haan P, Kalkman CJ, de Mol BA et al (1997) Efficacy of transcranial motor-evoked myogenic potentials to detect spinal cord ischemia during operations for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg 113: 87–100PubMedCrossRefGoogle Scholar
  24. 24.
    Coselli JS, LeMaire SA, de Figueiredo LP et al (1997) Paraplegia after thoracoabdominal aortic aneurysm repair: is dissection a risk factor? Ann Thorac Surg 63: 28–35PubMedCrossRefGoogle Scholar
  25. 25.
    de Mol B, Hamerlijnck R, Boezeman E et al (1990) Prevention of spinal cord ischemia in surgery of thoraco-abdominal aneurysms. The Bio Medicus pump, the recording of somatosensory evoked potentials and the impact on surgical strategy. Eur J Cardiothorac Surg 4: 658–664PubMedCrossRefGoogle Scholar
  26. 26.
    Coselli JS (1994) Thoracoabdominal aortic aneurysms: experience with 372 patients. J Card Surg 9: 638–647PubMedCrossRefGoogle Scholar
  27. 27.
    Safi HJ, Winnerkvist A, Miller CCr et al (1998) Effect of extended cross-clamp time during thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 66: 1204–1209PubMedCrossRefGoogle Scholar
  28. 28.
    Crawford ES, Mizrahi EM, Hess KR et al (1988) The impact of distal aortic perfusion and somatosensory evoked potential monitoring on prevention of paraplegia after aortic aneurysm operation. J Thorac Cardiovasc Surg 95: 357–367PubMedGoogle Scholar
  29. 29.
    Najafi H, Javid H, Hunter J et al (1980) Descending aortic aneurysmectomy without adjuncts to avoid ischemia. Ann Thorac Surg 30: 326–335PubMedCrossRefGoogle Scholar
  30. 30.
    Crawford ES, Rubio PA (1973) Reappraisal of adjuncts to avoid ischemia in the treatment of aneurysms of descending thoracic aorta. J Thorac Cardiovasc Surg 66: 693–704PubMedGoogle Scholar
  31. 31.
    Schepens MA, Defauw JJ, Hamerlijnck RP et al (1995) Use of left heart bypass in the surgical repair of thoracoabdominal aortic aneurysms. Ann Vasc Surg 9: 327–338PubMedCrossRefGoogle Scholar
  32. 32.
    Murray MJ, Bower TC, Oliver WC et al (1993) Effects of CSF drainage in patients undergoing thoracic and thoracoabdominal aortic surgery. J Cardiothor Vasc Anesth 7: 266–272CrossRefGoogle Scholar
  33. 33.
    Svensson LG, Groeneveld HT, Rickards ES et al (1986) Cross-clamping of the thoracic aorta. Influence of aortic shunts, laminectomy, papaverine, calcium channel blocker, allopurinol, and Superoxide dismutase on spinal cord blood flow and paraplegia in baboons. Ann Surg 204: 38–47PubMedCrossRefGoogle Scholar
  34. 34.
    Cunningham JJ, Laschinger JC, Spencer FC (1987) Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. IV. Clinical observations and results. J Thor Cardiovasc Surg 94: 275–285Google Scholar
  35. 35.
    Laschinger JC, Cunningham JJ, Baumann FG et al (1987) Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. II. Use of somatosensory evoked potentials to assess adequacy of distal aortic bypass and perfusion after thoracic aortic cross-clamping. J Thor Cardiovasc Surg 94: 266–270Google Scholar
  36. 36.
    Svensson LG, Rickards E, Coull A et al (1986) Relationship of spinal cord blood flow to vascular anatomy during thoracic aortic cross-clamping and shunting. J Thor Cardiovasc Surg 91: 71–78Google Scholar
  37. 37.
    Maharajh G, Pascoe EA, Halliday WC et al (1996) Neurological outcome in a porcine model of descending thoracic aortic surgery. Stroke 27: 2095–2101PubMedCrossRefGoogle Scholar
  38. 38.
    Domisse GF (1974) The blood supply of the spinal cord. J Bone and Joint Surg 56B:225–235Google Scholar
  39. 39.
    Wissdorf H (1970) Die Gefässversorgung der Wirbelsäule und des Rückenmarkes vom Hausschwein, Tierärztliche Hochschule Hannover, Med Vet Habilschrift. Berlin, Parey-Verlag, 73–96Google Scholar
  40. 40.
    Svensson LG, Loop FD Prevention of spinal ischemia in aortic surgery. Bergan JJ, Yao JST (eds) (1988) Arterial surgery: new diagnostic and operative techniques. New York, Grune&Sratton, 273–285Google Scholar
  41. 41.
    Svensson LG, Crawford ES, Hess KR et al (1993) Variables predictive of outcome in 832 patients undergoing repairs of the descending thoracic aorta. Chest 104: 1248–1253PubMedCrossRefGoogle Scholar
  42. 42.
    Blaisdell FW, Cooley DA (1962) The mechanism of paraplegia after temporary thoracic aortic occlusion and its relationship to spinal fluid pressure. Surgery 51: 351–355PubMedGoogle Scholar
  43. 43.
    Wadouh F, Lindeman EM, Arndt CF et al (1984) The arteria radicularis magna as a decisive factor influencing spinal cord damage during aortic occlusion. J Thor Cardiovasc Surg 88: 1–10Google Scholar
  44. 44.
    McCullough JL, Hollier LH, Nugent M (1988) Paraplegia after thoracic aortic occlusion: influence of cerebrospinal fluid drainage. Experimental and early clinical results. J Vasc Surg 7: 153–160PubMedGoogle Scholar
  45. 45.
    Berendes JN, Bredee JJ, Schipperheyn JJ et al (1982) Mechanisms of spinal cord injury after cross-clamping of the descending thoracic aorta. Circulation 66(suppl 1): 112–116Google Scholar
  46. 46.
    Stokland O, Molaug M, Ilebekk A et al (1980) Mechanism of hemodynamic responses to occlusion of the descending thoracic aorta. Am J Physiol 238:H423–H429PubMedGoogle Scholar
  47. 47.
    Piano G, Gewertz BL (1990) Mechanism of increased cerebrospinal fluid pressure with thoracic aortic occlusion. J Vasc Surg 11: 695–701PubMedGoogle Scholar
  48. 48.
    Griffiths IR, Pitts LH, Crawford RA et al (1978) Spinal cord compression and bloodflow. I. The effect of raised cerebrospinal fluid pressure on spinal cord blood flow. Neurology 28: 1145–1151PubMedCrossRefGoogle Scholar
  49. 49.
    Hickey R, Albin MS, Bunegin L et al (1986) Autoregulation of spinal cord blood flow: is the cord a microcosm of the brain? Stroke 17: 1183–1189PubMedCrossRefGoogle Scholar
  50. 50.
    Grubbs PE, Jr., Marini C, Toporoff B et al (1988) Somatosensory evoked potentials and spinal cord perfusion pressure are significant predictors of postoperative neurologic dysfunction. Surgery 104: 216–223PubMedGoogle Scholar
  51. 51.
    Marini CP, Grubbs PE, Toporoff B et al (1989) Effect of sodium nitroprusside on spinal cord perfusion and paraplegia during aortic cross-clamping. Ann Thorac Surg 47: 379–383PubMedCrossRefGoogle Scholar
  52. 52.
    Marini CP, Nathan IM, Efron J et al (1997) Effect of nitroglycerin and cerebrospinal fluid drainage on spinal cord perfusion pressure and paraplegia during aortic cross-clamping. J Surg Res 70: 61–65PubMedCrossRefGoogle Scholar
  53. 53.
    Bower TC, Murray MJ, Gloviczki P et al (1988) Effects of thoracic aortic occlusion and cerebrospinal fluid drainage on regional spinal cord blood flow in dogs: correlation with neurologic outcome. J Vasc Surg 9: 135–144Google Scholar
  54. 54.
    Woloszyn TT, Marini CP, Coons MS et al (1992) A multimodality approach lengthens warm ischemic time during aortic cross-clamping. J Surg Res 52: 15–21PubMedCrossRefGoogle Scholar
  55. 55.
    Woloszyn TT, Marini CP, Coons MS et al (1990) Cerebrospinal fluid drainage and steroids provide better spinal cord protection during aortic cross-clamping than does either treatment alone. Ann Thorac Surg 49: 78–82PubMedCrossRefGoogle Scholar
  56. 56.
    Elmore JR, Gloviczki P, Harper CM et al (1991) Failure of motor evoked potentials to predict neurologic outcome in experimental thoracic aortic occlusion. J Vasc Surg 14: 131–139PubMedCrossRefGoogle Scholar
  57. 57.
    Wisselink W, Becker MO, Nguyen JH et al (1994) Protecting the ischemic spinal cord during aortic clamping: the influence of selective hypothermia and spinal cord perfusion pressure. J Vasc Surg 19: 788–795PubMedCrossRefGoogle Scholar
  58. 58.
    Hollier LH, Money SR, Naslund TC et al(1992) Risk of spinal cord dysfunction in patients undergoing thoracoabdominal aortic replacement. Am J Surg 164: 210–213PubMedCrossRefGoogle Scholar
  59. 59.
    Acher CW, Wynn MM, Archibald J (1990) ai]Naloxone_and spinal fluid drainage as adjuncts in the surgical treatment of thoracoabdominal and thoracic aneurysms Surgery 108: 755–761PubMedGoogle Scholar
  60. 60.
    Acher CW, Wynn MM, Hoch JR et al (1994) Combined use of cerebral spinal fluid drainage and naloxone reduces the risk of paraplegia in thoracoabdominal aneurysm repair. J Vasc Surg 19: 236–246PubMedCrossRefGoogle Scholar
  61. 61.
    Mutch WA (1995) Control of outflow pressure provides spinal cord protection during resection of descending thoracic aortic aneurysms. J Neurosurg Anesthesiol 7: 133–138PubMedCrossRefGoogle Scholar
  62. 62.
    Woloszyn TT, Marini CP, Coons MS et al (1989) Cerebrospinal fluid drainage does not counteract the negative effect of sodium nitroprusside on spinal cord perfusion pressure during aortic cross-clamping. Current Surgery 46: 489–492PubMedGoogle Scholar
  63. 63.
    Marini CP, Levison J, Caliendo F et al (1998) Control of proximal hypertension during aortic cross-clamping: its effect on cerebrospinal fluid dynamics and spinal cord perfusion pressure. Semin Thorac Cardiovasc Surg 10: 51–56PubMedGoogle Scholar
  64. 64.
    Dohi S, Matsumoto M, Takahashi T (1981) The effects of nitroglycerin on cerebrospinal fluid pressure in awake and anesthetized humans. Anesthesiology 54: 511–514PubMedCrossRefGoogle Scholar
  65. 65.
    Williams GM, Perler BA, Burdick JF et al (1991) Angiographie localization of spinal cord blood supply and its relationship to postoperative paraplegia. J Vasc Surg 13: 23–33PubMedCrossRefGoogle Scholar
  66. 66.
    Safi HJ, Miller CCr, Carr C et al (1998) Importance of intercostal artery reattachment during thoracoabdominal aortic aneurysm repair. J Vasc Surg 27: 58–66PubMedCrossRefGoogle Scholar
  67. 67.
    Svensson LG, Klepp P, Hinder RA (1986) Spinal cord anatomy of the baboon-comparison with man and implications for spinal cord blood flow during thoracic aortic cross-clamping. S Afr J Surg 24: 32–34PubMedGoogle Scholar
  68. 68.
    Kouchoukos NT, Wareing TH, Izumoto H et al (1990) Elective hypothermic cardiopulmonary bypass and circulatory arrest for spinal cord protection during operations on the thoracoabdominal aorta. J Thorac Cardiovasc Surg 99: 659–64PubMedGoogle Scholar
  69. 69.
    Wadouh F, Arndt CF, Oppermann E et al (1986) The mechanism of spinal cord injury after simple and double aortic cross-clamping. J Thorac Cardiovasc Surg 92: 121–127PubMedGoogle Scholar
  70. 70.
    Dapunt OE, Midulla PS, Sadeghi AM et al (1994) Pathogenesis of spinal cord injury during simulated aneurysm repair in a chronic animal model. Ann Thorac Surg 58: 689–696PubMedCrossRefGoogle Scholar
  71. 71.
    Schepens MA, Defauw JJ, Hamerlijnck RP et al (1994) Surgical treatment of thoracoabdominal aortic aneurysms by simple cross-clamping. Risk factors and late results. J Thorac Cardiovasc Surg 107: 134–142PubMedGoogle Scholar
  72. 72.
    Svensson LG, Patel V, Robinson MF et al (1991) Influence of preservation or perfusion of intraoperatively identified spinal cord blood supply on spinal motor evoked potentials and paraplegia after aortic surgery. J Vasc Surg 13: 355–365PubMedCrossRefGoogle Scholar
  73. 73.
    Szilagyi DE, Hageman JH, Smith RF et al (1978) Spinal cord damage in surgery of the abdominal aorta. Surgery 83: 38–56PubMedGoogle Scholar
  74. 74.
    Kieffer E, Richard T, Chiras J et al (1989) Preoperative spinal cord arteriography in aneurysmal disease of the descending thoracic and thoracoabdominal aorta: Preliminary results in 45 patients. Ann Vasc Surg 3: 34–46PubMedCrossRefGoogle Scholar
  75. 75.
    Savader SJ, Williams GM, Trerotola SO et al (1993) Preoperative spinal artery localization and its relationship to postoperative neurologic complications. Radiology 189: 165–171PubMedGoogle Scholar
  76. 76.
    Heinemann MK, Brassel F, Herzog T et al (1998) The role of spinal angiography in operations on the thoracic aorta: myth or reality? Ann Thorac Surg 65: 346–351PubMedCrossRefGoogle Scholar
  77. 77.
    Svensson LG (1996) Intraoperative identification of spinal cord blood supply during repairs of descending aorta and thoracoabdominal aorta. J Thorac Cardiovasc Surg 112: 1455–1460PubMedCrossRefGoogle Scholar
  78. 78.
    Svensson LG, Crawford ES, Patel V et al (1992) Spinal oxygenation, blood supply localization, cooling, and function with aortic clamping. Ann Thorac Surg 54: 74–79PubMedCrossRefGoogle Scholar
  79. 79.
    Allen BT, Davis CG, Osborne D et al (1994) Spinal cord ischemia and reperfusion metabolism: the effect of hypothermia. J Vasc Surg 19: 332–339PubMedCrossRefGoogle Scholar
  80. 80.
    Harreveld van A, Tyler DB (1944) Influence of temperature on spinal cord damage caused by asphyxiation. Am J Physiol 142: 32Google Scholar
  81. 81.
    Rokkas CK, Cronin CS, Nitta T et al (1995) Profound systemic hypothermia inhibits the release of neurotransmitter amino acids in spinal cord ischemia. J Thorac Cardiovasc Surg 110: 27–35PubMedCrossRefGoogle Scholar
  82. 82.
    Kouchoukos NT, Daily BB, Rokkas CK et al (1995) Hypothermie bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg 60: 67–76PubMedGoogle Scholar
  83. 83.
    Ergin MA, Galla JD, Lansman L et al (1994) Hypothermie circulatory arrest in operations on the thoracic aorta. Determinants of operative mortality and neurologic outcome. J Thorac Cardiovasc Surg 107: 788–797PubMedGoogle Scholar
  84. 84.
    Kieffer E, Koskas F, Waiden R et al (1994) Hypothermie circulatory arrest for thoracic aneurysmectomy through left-sided thoracotomy. J Vasc Surg 19: 457–464PubMedCrossRefGoogle Scholar
  85. 85.
    Safi HJ, Miller CCr, Subramaniam MH et al (1998) Thoracic and thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass, profound hypothermia, and circulatory arrest via left side of the chest incision. J Vasc Surg 28: 591–598PubMedCrossRefGoogle Scholar
  86. 86.
    Frank SM, Parker SD, Rock P et al (1994) Moderate hypothermia, with partial bypass and segmental sequential repair for thoracoabdominal aortic aneurysm. J Vasc Surg 19: 687–697PubMedCrossRefGoogle Scholar
  87. 87.
    Marsala M, Vanicky I, Yaksh TL (1994) Effect of graded hypothermia (27 degrees to 34 degrees C) on behavioral function, histopathology, and spinal blood flow after spinal ischemia in rat. Stroke 25: 2038–2046PubMedCrossRefGoogle Scholar
  88. 88.
    Busto R, Dietrich W, Globus M et al (1987) Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 7: 729–738PubMedCrossRefGoogle Scholar
  89. 89.
    Salzano RJ, Ellison LH, Altonji PF et al (1994) Regional deep hypothermia of the spinal cord protects against ischemic injury during thoracic aortic cross-clamping. Ann Thorac Surg 57: 65–70PubMedCrossRefGoogle Scholar
  90. 90.
    Berguer R, Porto J, Fedoronko B et al (1992) Selective deep hypothermia of the spinal cord prevents paraplegia after aortic cross-clamping in the dog model. J Vasc Surg 15: 62–71PubMedCrossRefGoogle Scholar
  91. 91.
    Vanicky I, Marsala M, Galik J et al (1993) Epidural perfusion cooling protection against protracted spinal cord ischemia in rabbits. J Neurosurg 79: 736–741PubMedCrossRefGoogle Scholar
  92. 92.
    Marsala M, Vanicky I, Galik J et al (1993) Panmyelic epidural cooling protects against ischemic spinal cord damage. J Surg Res 55: 21–31PubMedCrossRefGoogle Scholar
  93. 93.
    Tabayashi K, Niibori K, Konno H et al (1993) Protection from postischemic spinal cord injury by perfusion cooling of the epidural space. Ann Thorac Surg 56: 494–498PubMedCrossRefGoogle Scholar
  94. 94.
    Gonzalez-Fajardo J, Beatriz A, Perez-Burkhardt JL et al (1996) Epidural regional hypothermia for prevention of paraplegia after aortic occlusion: experimental evaluation in a rabbit model. J Vasc Surg 23: 446–452PubMedCrossRefGoogle Scholar
  95. 95.
    Cambria RP, Davison JK, Zannetti S et al (1997) Clinical experience with epidural cooling for spinal cord protection during thoracic and thoracoabdominal aneurysm repair. J Vasc Surg 25: 234–241PubMedCrossRefGoogle Scholar
  96. 96.
    Davison JK, Cambria RP, Vieira DJ et al (1994) Epidural cooling for regional spinal cord hypothermia during thoracoabdominal aneurysm repair. J Vasc Surg 20: 304–310PubMedCrossRefGoogle Scholar
  97. 97.
    Colon R, Frazier OH, Cooley DA et al (1987) Hypothermie regional perfusion for protection of the spinal cord during periods of ischemia. Ann Thorac Surg 43: 639–643PubMedCrossRefGoogle Scholar
  98. 98.
    Coles JG, Wilson GJ, Sima AF et al (1983) Intraoperative management of thoracic aortic aneurysm, experimental evaluation of perfusion cooling of the spinal cord. J Thorac Cardiovasc Surg 85: 292–299PubMedGoogle Scholar
  99. 99.
    Malatova Z, Vanicky I, Galik J et al (1995) Epidural perfusion cooling protects against spinal cord ischemia in rabbits. An evaluation of cholinergic function. Mol Chem Neuropathol 25: 81–96PubMedCrossRefGoogle Scholar
  100. 100.
    Herold JA, Krön IL, Langenburg SE et al (1994) Complete prevention of postischemic spinal cord injury by means of regional infusion with hypothermic saline and adenosine. J Thorac Cardiovasc Surg 107: 536–541PubMedGoogle Scholar
  101. 101.
    Fehrenbacher JW, McCready RA, Hormuth DA et al (1993) One-stage segmental resection of extensive thoracoabdominal aneurysms with left-sided heart bypass. J Vasc Surg 18: 366–370PubMedCrossRefGoogle Scholar
  102. 102.
    Karibe H, Chen J, Zarow GJ et al (1994) Delayed induction of mild hypothermia to reduce infarct volume after temporary middle cerebral artery occlusion in rats. J Neurosurg 80: 112–119PubMedCrossRefGoogle Scholar
  103. 103.
    Craenen G, Jeftinija S, Grants I et al (1996) The role of excitatory amino acids in hypothermic injury to mammalian spinal cord neurons. J Neurotrauma 13: 809–818PubMedCrossRefGoogle Scholar
  104. 104.
    Svensson LG, Grum DF, Bednarski M et al (1990) Appraisal of cerebrospinal fluid alterations during aortic surgery with intrathecal papaverine administration and cerebrospinal fluid drainage. J Vasc Surg 11: 423–429PubMedGoogle Scholar
  105. 105.
    Hill AB, Kaiman PG, Johnston KW et al (1994) Reversal of delayed-onset paraplegia after thoracic aortic surgery with cerebrospinal fluid drainage. J Vasc Surg 20: 315–317PubMedCrossRefGoogle Scholar
  106. 106.
    Safi HJ, Miller CCr, Azizzadeh A et al (1997) Observations on delayed neurologic deficit after thoracoabdominal aortic aneurysm repair. J Vasc Surg 26: 616–622PubMedCrossRefGoogle Scholar
  107. 107.
    Wu YP, Ling EA (1998) Induction of microglial and astrocytic response in the adult rat lumbar spinal cord following middle cerebral artery occlusion. Exp Brain Res 118: 235–242PubMedCrossRefGoogle Scholar
  108. 108.
    Lindsberg PJ, Yue TL, Frerichs KU et al (1990) Evidence for platelet-activating factor as a novel mediator in experimental stroke in rabbits. Stroke 21: 1452–1457PubMedCrossRefGoogle Scholar
  109. 109.
    Lindsberg PJ, Siren AL, Feuerstein GZ et al (1995) Antagonism of neutrophil adherence in the deteriorating stroke model in rabbits. J Neurosurg 82: 269–277PubMedCrossRefGoogle Scholar
  110. 110.
    Barut S, Canbolat A, Bilge T et al (1993) Lipid peroxidation in experimental spinal cord injury: time-level relationship. Neurosurg Rev 16: 53–59PubMedCrossRefGoogle Scholar
  111. 111.
    Hayashi T, Sakurai M, Abe K et al (1998) Apoptosis of motor neurons with induction of caspases in the spinal cord after ischemia. Stroke 29: 1007–1012PubMedCrossRefGoogle Scholar
  112. 112.
    Kato H, Kanellopoulos GK, Matsuo S et al (1997) Neuronal apoptosis and necrosis following spinal cord ischemia in the rat. Exp Neurol 148: 464–474PubMedCrossRefGoogle Scholar
  113. 113.
    Sakurai M, Hayashi T, Abe K et al (1998) Delayed selective motor neuron death and Fas antigen induction after spinal cord ischemia in rabbits. Brain Res 797: 23–28PubMedCrossRefGoogle Scholar
  114. 114.
    Sakurai M, Hayashi T, Abe K et al (1998) Delayed and selective motor neuron death after transient spinal cord ischemia: a role of apoptosis? J Thorac Cardiovasc Surg 115: 1310–1315PubMedCrossRefGoogle Scholar
  115. 115.
    Bredesen DE (1995) Neural Apoptosis. Ann Neurol 38: 839–851PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • P. de Haan
    • 1
  • J. Kesecioglu
    • 2
  1. 1.Department of AnaesthesiologyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  2. 2.Department of Intensive CareUniversity of Amsterdam, Academic Medical CentreAmsterdamThe Netherlands

Personalised recommendations