Influence of preservation or perfusion of intraoperatively identified spinal cord blood supply on spinal motor evoked potentials and paraplegia after.

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Presentation transcript:

Influence of preservation or perfusion of intraoperatively identified spinal cord blood supply on spinal motor evoked potentials and paraplegia after aortic surgery Lars G. Svensson, MB, PhD, Vasishta Patel, MD, Marion F. Robinson, PhD, Toshihiko Ueda, MD, John O.F. Roehm, MD, E.Stanley Crawford, MD, MD Journal of Vascular Surgery Volume 13, Issue 3, Pages 355-365 (March 1991) DOI: 10.1067/mva.1991.26137 Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Demonstration of segmental occlusion of aorta and testing for HICI responses in porcine experiments. Arteries supplying the spinal cord were either divided or preserved as described in Methods section. H2, Hydrogen; P, mean arterial pressure; HICI, recorded hydrogen-induced current impulse; SMEP, spinal motor evoked potentials; ASA, anterior spinal artery; ARM, arteria radicularis magna; L, lumbar artery level. Journal of Vascular Surgery 1991 13, 355-365DOI: (10.1067/mva.1991.26137) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Diagram of cross-clamped aorta and shunt perfusing HICI localized arteries supplying the spinal cord in porcine experiments. T, Thoracic level; L, lumbar level; MAP, mean arterial pressure; P, platinum electrode; S, stainless steel electrode. Journal of Vascular Surgery 1991 13, 355-365DOI: (10.1067/mva.1991.26137) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Spinal motor evoked potentials amplitude data for porcine experiments during segmental testing and at 5-minute intervals after division of segmental arteries. Journal of Vascular Surgery 1991 13, 355-365DOI: (10.1067/mva.1991.26137) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Changes in SMEP amplitude height during aortic cross-clamping and after unclamping in porcine experiments (n = 4) in which postoperative paralysis did not occur. During cross-clamping HICI testing was performed and perfusion shunts were connected to arteries supplying the spinal cord, whereas those not supplying the spinal cord were clipped and divided (see Methods section). Journal of Vascular Surgery 1991 13, 355-365DOI: (10.1067/mva.1991.26137) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 A, Segmental testing in patient 1C (see Table I) and HICI responses. H2, Hydrogen; T-10, thoracic level 10. The replacement aortic graft was beveled to preserve T-10 (in windows or right side) and then retested for patency, which confirmed the artery at T-10 supplying the spinal cord had been successfully preserved. B, Highly selective computerized digital arteriogram and diagram of spinal cord with arteria radicularis magna (ARM). The anterior spinal artery and ARM are indicated by arrows on the arteriogram. Journal of Vascular Surgery 1991 13, 355-365DOI: (10.1067/mva.1991.26137) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Segmental testing in patient 2G (see Table I) and HICI response from injection of hydrogen (H2) into atriofemoral bypass pump. Arteriograms showed that T-9 and T-10 intercostal arteries supplied the spinal cord distal to the graft replacement. Journal of Vascular Surgery 1991 13, 355-365DOI: (10.1067/mva.1991.26137) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 A, HICI testing in patient 3C (see Table I) with previous elephant trunk repair of proximal aorta. Both segmental and cannulation of individual intercostal artery ostia with HICI testing was performed. B, Reanastomosis of T-11 and testing for patency of intercostal arteries supplying the spinal cord. C, Arteriogram of intercostal artery (left T-11) and leash of collateral vessels supplying the cord. Journal of Vascular Surgery 1991 13, 355-365DOI: (10.1067/mva.1991.26137) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions