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Ann Thorac Surg 2002;74:S1873-S1876
© 2002 The Society of Thoracic Surgeons

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Session 4: Descending/Thoracoabdominal Aorta

Intraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery

^a Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
^b Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

* Address reprint requests to Dr Dong, EEG Lab, CP Ground Floor, Vancouver General Hospital, 855 West 12th Ave, Vancouver, BC V5Z 1M9 Canada
e-mail: cdong{at}interchg.ubc.ca

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

Abstract

BACKGROUND: Postoperative paraplegia is one of the most dreaded complications after descending thoracic and thoracoabdominal aneurysm surgery. In this study, intraoperative monitoring was applied during resection of descending thoracic and thoracoabdominal aneurysms to detect spinal cord ischemia and help prevent paraplegia.

METHODS: Fifty-six patients (descending thoracic, 25; thoracoabdominal, 31) were monitored intraoperatively with both motor- (MEP) and somatosensory- (SSEP) evoked potentials. MEPs were elicited with transcranial electrical stimulation and recorded from the spinal epidural space (D wave) or peripheral muscles (myogenic MEP). SSEPs were obtained with median and tibial nerve stimulation.

RESULTS: A total of 16 patients (28.6%) showed MEP evidence of spinal cord ischemia, only 4 of whom had delayed congruent SSEP changes. In 13 patients (23.2%), ischemic changes in MEPs were reversed by reimplanting segmental arteries or increasing blood flow or blood pressure. None of these 13 patients suffered acute paraplegia regardless of the status of SSEP at the end of the procedure, but 1 of them developed delayed postoperative paraplegia after multisystem failure. Three patients (5.4%) who had persistent loss of MEPs despite of recovery of SSEPs awoke paraplegic.

CONCLUSIONS: The results demonstrate that compared with SSEP, MEP, especially myogenic MEP, is more sensitive and specific in detection of spinal cord ischemia, and that intraoperative monitoring can indeed help prevent paraplegia.

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