Assessment of Spinal Cord Circulation and Function in Endovascular Treatment of Thoracic Aortic Aneurysms Geert Willem H. Schurink, MD, PhD, Robbert.

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Assessment of Spinal Cord Circulation and Function in Endovascular Treatment of Thoracic Aortic Aneurysms Geert Willem H. Schurink, MD, PhD, Robbert J. Nijenhuis, MD, Walter H. Backes, PhD, Werner Mess, MD, PhD, Michiel W. de Haan, MD, PhD, Bas Mochtar, MD, PhD, Michael J. Jacobs, MD, PhD The Annals of Thoracic Surgery Volume 83, Issue 2, Pages S877-S881 (February 2007) DOI: 10.1016/j.athoracsur.2006.11.028 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Sagittal maximum intensity projection image of a 68-year-old man showing the aorta, segmental arteries (SAs), and intersegmental collaterals (arrowheads). Note that not all SAs have an open connection with the aorta. (B) In the coronal oblique multiplanar reformatted image, the spinal cord blood supply pathway to the Adamkiewicz artery (AKA [arrow]) is depicted. Segmental artery thoracic 10 (T10), which has a direct connection with the AKA, is occluded in the aortic wall (asterisk). The SA T10 and thereby the AKA are supplied by SA thoracic 11 (T11) through an intersegmental collateral (arrowhead). The distal landing zone of the thoracic stent graft did not cover SA T11, thereby ensuring blood supply to the AKA. The Annals of Thoracic Surgery 2007 83, S877-S881DOI: (10.1016/j.athoracsur.2006.11.028) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Motor evoked potential (MEP) registration during endovascular exclusion of a distal descending thoracic aneurysm. The MEP registration of the left anterior tibial muscle (TAL [dashed line]) and the right anterior tibial muscle (TAR [solid line]) and the mean arterial pressure (MAP [broken line]) are reflected. The MEPs decrease to 30% of the initial value (MEPs to the arms stay unchanged). After elevation of the MAP, the MEPs increase to above 50%. The Annals of Thoracic Surgery 2007 83, S877-S881DOI: (10.1016/j.athoracsur.2006.11.028) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions