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Ann Thorac Surg 2002;74:S1867-S1869
© 2002 The Society of Thoracic Surgeons

Session 4: Descending/Thoracoabdominal Aorta

State-of-the-art of neuromonitoring for prevention of immediate and delayed paraplegia in thoracic and thoracoabdominal aorta surgery

Jean-Michel Guérit, MDa*, Robert A. Dion, MDb

a Cliniques Universitaires St-Luc, Catholic University of Louvain, Brussels, Belgium
b Leids Universitair Medisch Centrum, Leiden, The Netherlands

* Address reprint requests to Dr Guérit, Service "Potentiels Evoqués," Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200 Brussels, Belgium
e-mail: guerit{at}nchm.ucl.ac.be

Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.

Abstract

BACKGROUND: The prevention of immediate and delayed paraplegia after thoracoabdominal aorta surgery relies on hemodynamic maneuvers (aimed at restoration of an adequate spinal cord perfusion pressure) and cytoprotective measures (hypothermia, drugs).

METHODS: The indications for implementing these measures can be provided by motor-evoked potential (MEP) or somatosensory-evoked potential (SEP) monitoring.

RESULTS: Intraoperative interactions between the surgeon and the neurophysiologist can be described by algorithms to be applied in the presence or absence of intraoperative MEP or SEP changes.

CONCLUSIONS: It should be noted that normal SEPs or MEPs at the end of surgery do not systematically guarantee the nonoccurrence of delayed paraplegia, especially when segmental arteries have been ligated, in which case postoperative SEP monitoring is indicated.




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