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Eur J Cardiothorac Surg 2006;29:392-396
© 2006 Elsevier Science NL

Neurophysiological monitoring during thoracoabdominal aortic endovascular stent graft implantation

^a Department of Cardiovascular Surgery, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
^b Department of Neurosurgery, University Hospital Freiburg, Germany

Received 28 September 2005; received in revised form 21 November 2005; accepted 23 November 2005.

^_* Corresponding author. Tel.: +49 761 270 2881; fax: +49 761 270 2368. (Email: weigang{at}ch11.ukl.uni-freiburg.de; hartert{at}ch11.ukl.uni-freiburg.de).

Objective: The aim of this study was to evaluate the benefit of neurophysiological monitoring during thoracic and thoracoabdominal endovascular stent graft implantation. Methods: The spinal cords of 21 patients undergoing endovascular stent graft implantation on the thoracic and thoracoabdominal aorta were monitored with transcranial motor-evoked potentials (tcMEP) and somatosensory-evoked potentials (SSEP). All patients underwent mild systemic hypothermia (34–35 °C), constant cerebrospinal fluid (CSF) pressure and vital parameter monitoring. If CSF pressure exceeded 15 mmHg, CSF-drainage was carried out. Results: Three of the 21 patients (14%) exhibited short-term loss of tcMEP and SSEP after the deployment of the self-expanding endoprosthesis. We observed an intraoperative recovery of the evoked potentials in all cases. CSF-drainage was necessary in three of them. One patient, whose potentials were stable intraoperatively, developed paraparesis 3 weeks after the intervention. Conclusions: Neurophysiological monitoring has proved to be an ideal monitoring method to detect spinal cord ischemia during thoracic and thoracoabdominal endovascular stent graft implantation. Due to the advantages of endovascular therapy (no aortic cross-clamping, continuous distal perfusion, and no reperfusion injury), changes in potentials were seldom observed.

Key Words: Aortic surgery • Endovascular stent graft implantation • Thoracoabdominal aorta • Spinal cord protection • Neurophysiological monitoring

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