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M J Jacobs - One of the best experts on this subject based on the ideXlab platform.
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Monitoring Spinal Cord Function in Open and Endovascular Treatment of Thoracoabdominal Aortic Pathologies
Surgical Management of Aortic Pathology, 2019Co-Authors: Barend Mees, G W H Schurink, W Mess, Noud Peppelenbosch, M J JacobsAbstract:Spinal Cord ischemia is one of the most dreadful complications of thoracic and thoracoabdominal aortic surgery. The complex mechanisms of Spinal Cord perfusion under iatrogenic circumstances, such as surgery, are still not fully unraveled. Neuromonitoring during open and endovascular aortic surgery aims at assessing perioperative Spinal Cord Function, allowing corrective measures in case of compromised Spinal Cord perfusion and thus reducing the incidence of postoperative Spinal Cord ischemia. The technique of motor evoked potentials is a reliable and highly accurate method to evaluate Spinal Cord integrity during thoracic and thoracoabdominal aortic repair.
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Spinal Cord Function monitoring during endovascular treatment of thoracoabdominal aneurysms: implications for staged procedures.
Journal of Cardiovascular Surgery, 2013Co-Authors: G W H Schurink, M W De Haan, A G Peppelenbosch, W Mess, M J JacobsAbstract:Aim Spinal Cord ischemia is a well-known complication in the treatment of thoracoabdominal aneurysms (TAAA). Despite the fact that endovascular treatment of TAAA is less invasive, Spinal Cord ischemia rate is not reduced if compared to open repair. Methods We report the results of our experience of Spinal Cord Function monitoring by measuring motor evoked potentials (MEP) during endovascular treatment of TAAA type II and III. Depending on the level of the MEPs the decision is made whether to stage the procedure or not. We treated ten patients acCording to this protocol. Results In two patients, MEPs decreased 50% or more and procedures were staged. Both experienced no neurological complications after first and second procedure. No MEPs decrease was seen during the second procedures. One of the other eight patients had a temporary right lower leg pararesis. Conclusion In conclusion we state that our first experience demonstrates the value of assessing Spinal Cord Function during extensive endovascular TAAA repair with subsequent strategies to prevent paraplegia.
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Spinal Cord Function monitoring during endovascular treatment of thoracoabdominal aneurysms: implications for staged procedures.
The Journal of cardiovascular surgery, 2013Co-Authors: G W H Schurink, M W De Haan, A G Peppelenbosch, W Mess, M J JacobsAbstract:Spinal Cord ischemia is a well-known complication in the treatment of thoracoabdominal aneurysms (TAAA). Despite the fact that endovascular treatment of TAAA is less invasive, Spinal Cord ischemia rate is not reduced if compared to open repair. We report the results of our experience of Spinal Cord Function monitoring by measuring motor evoked potentials (MEP) during endovascular treatment of TAAA type II and III. Depending on the level of the MEPs the decision is made whether to stage the procedure or not. We treated ten patients acCording to this protocol. In two patients, MEPs decreased 50% or more and procedures were staged. Both experienced no neurological complications after first and second procedure. No MEPs decrease was seen during the second procedures. One of the other eight patients had a temporary right lower leg pararesis. In conclusion we state that our first experience demonstrates the value of assessing Spinal Cord Function during extensive endovascular TAAA repair with subsequent strategies to prevent paraplegia.
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Neurological Monitoring with Evoked Potentials
Thoraco-Abdominal Aorta, 2011Co-Authors: M J Jacobs, W MessAbstract:The aim of perioperative neurological monitoring is to assess Spinal Cord Function during aortic cross-clamping, allowing corrective measures in case of jeopardized Spinal Cord perfusion. The technique of motor evoked potentials is a reliable and highly sensitive method to evaluate Spinal Cord integrity during thoraco-abdominal aortic repair. Using this technique, critical Spinal Cord Function can be determined and improved by surgical and hemodynamic interactions in order to prevent neurological deficits.
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magnetic resonance angiography of collateral blood supply to Spinal Cord in thoracic and thoracoabdominal aortic aneurysm patients
Journal of Vascular Surgery, 2008Co-Authors: Walter H Backes, G W H Schurink, W Mess, M J Jacobs, Robbert J Nijenhuis, Freke A WilminkAbstract:Objective Preservation of Spinal Cord blood supply during descending thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) surgery is mandatory to prevent neurologic complications. Although collateral arteries have been identified occasionally and are considered crucial for maintaining Spinal Cord Function in the individual patient, their critical Functionality is poorly understood and very little experience exists with visualization. This study investigated whether the preoperative and postoperative presence or absence of collateral arteries detected by magnetic resonance angiography (MRA) is related to Spinal Cord Function during the intraoperative exclusion of the segmental supply to the Adamkiewicz artery. Methods Spinal Cord MRA was used to localize the Adamkiewicz artery and its segmental supplier in 85 patients scheduled for open elective surgery for TAA or TAAA. The segmental artery to the Adamkiewicz artery was inside the cross-clamped aortic area in 55 patients, and Spinal Cord supply was consequently dependent on collateral supply. In these 55 patients the presence of collaterals originating from arteries outside the cross-clamped aortic segment was related to changes in the intraoperative motor-evoked potentials (MEPs) that occurred before corrective measures. Twenty-one patients returned for postoperative MRA. Results A highly significant ( P Conclusion Collateral arteries supplying the Spinal Cord can be systematically visualized using MRA. Spinal Cord blood supply during open aortic surgery may crucially depend on collateral arteries. Preoperatively identified collateral supply was 97% predictive for stable intraoperative Spinal Cord Function. Patients in whom no collaterals can be depicted preoperatively are at increased risk for Spinal Cord dysFunction.
G W H Schurink - One of the best experts on this subject based on the ideXlab platform.
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Monitoring Spinal Cord Function in Open and Endovascular Treatment of Thoracoabdominal Aortic Pathologies
Surgical Management of Aortic Pathology, 2019Co-Authors: Barend Mees, G W H Schurink, W Mess, Noud Peppelenbosch, M J JacobsAbstract:Spinal Cord ischemia is one of the most dreadful complications of thoracic and thoracoabdominal aortic surgery. The complex mechanisms of Spinal Cord perfusion under iatrogenic circumstances, such as surgery, are still not fully unraveled. Neuromonitoring during open and endovascular aortic surgery aims at assessing perioperative Spinal Cord Function, allowing corrective measures in case of compromised Spinal Cord perfusion and thus reducing the incidence of postoperative Spinal Cord ischemia. The technique of motor evoked potentials is a reliable and highly accurate method to evaluate Spinal Cord integrity during thoracic and thoracoabdominal aortic repair.
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Spinal Cord Function monitoring during endovascular treatment of thoracoabdominal aneurysms: implications for staged procedures.
Journal of Cardiovascular Surgery, 2013Co-Authors: G W H Schurink, M W De Haan, A G Peppelenbosch, W Mess, M J JacobsAbstract:Aim Spinal Cord ischemia is a well-known complication in the treatment of thoracoabdominal aneurysms (TAAA). Despite the fact that endovascular treatment of TAAA is less invasive, Spinal Cord ischemia rate is not reduced if compared to open repair. Methods We report the results of our experience of Spinal Cord Function monitoring by measuring motor evoked potentials (MEP) during endovascular treatment of TAAA type II and III. Depending on the level of the MEPs the decision is made whether to stage the procedure or not. We treated ten patients acCording to this protocol. Results In two patients, MEPs decreased 50% or more and procedures were staged. Both experienced no neurological complications after first and second procedure. No MEPs decrease was seen during the second procedures. One of the other eight patients had a temporary right lower leg pararesis. Conclusion In conclusion we state that our first experience demonstrates the value of assessing Spinal Cord Function during extensive endovascular TAAA repair with subsequent strategies to prevent paraplegia.
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Spinal Cord Function monitoring during endovascular treatment of thoracoabdominal aneurysms: implications for staged procedures.
The Journal of cardiovascular surgery, 2013Co-Authors: G W H Schurink, M W De Haan, A G Peppelenbosch, W Mess, M J JacobsAbstract:Spinal Cord ischemia is a well-known complication in the treatment of thoracoabdominal aneurysms (TAAA). Despite the fact that endovascular treatment of TAAA is less invasive, Spinal Cord ischemia rate is not reduced if compared to open repair. We report the results of our experience of Spinal Cord Function monitoring by measuring motor evoked potentials (MEP) during endovascular treatment of TAAA type II and III. Depending on the level of the MEPs the decision is made whether to stage the procedure or not. We treated ten patients acCording to this protocol. In two patients, MEPs decreased 50% or more and procedures were staged. Both experienced no neurological complications after first and second procedure. No MEPs decrease was seen during the second procedures. One of the other eight patients had a temporary right lower leg pararesis. In conclusion we state that our first experience demonstrates the value of assessing Spinal Cord Function during extensive endovascular TAAA repair with subsequent strategies to prevent paraplegia.
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magnetic resonance angiography of collateral blood supply to Spinal Cord in thoracic and thoracoabdominal aortic aneurysm patients
Journal of Vascular Surgery, 2008Co-Authors: Walter H Backes, G W H Schurink, W Mess, M J Jacobs, Robbert J Nijenhuis, Freke A WilminkAbstract:Objective Preservation of Spinal Cord blood supply during descending thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) surgery is mandatory to prevent neurologic complications. Although collateral arteries have been identified occasionally and are considered crucial for maintaining Spinal Cord Function in the individual patient, their critical Functionality is poorly understood and very little experience exists with visualization. This study investigated whether the preoperative and postoperative presence or absence of collateral arteries detected by magnetic resonance angiography (MRA) is related to Spinal Cord Function during the intraoperative exclusion of the segmental supply to the Adamkiewicz artery. Methods Spinal Cord MRA was used to localize the Adamkiewicz artery and its segmental supplier in 85 patients scheduled for open elective surgery for TAA or TAAA. The segmental artery to the Adamkiewicz artery was inside the cross-clamped aortic area in 55 patients, and Spinal Cord supply was consequently dependent on collateral supply. In these 55 patients the presence of collaterals originating from arteries outside the cross-clamped aortic segment was related to changes in the intraoperative motor-evoked potentials (MEPs) that occurred before corrective measures. Twenty-one patients returned for postoperative MRA. Results A highly significant ( P Conclusion Collateral arteries supplying the Spinal Cord can be systematically visualized using MRA. Spinal Cord blood supply during open aortic surgery may crucially depend on collateral arteries. Preoperatively identified collateral supply was 97% predictive for stable intraoperative Spinal Cord Function. Patients in whom no collaterals can be depicted preoperatively are at increased risk for Spinal Cord dysFunction.
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magnetic resonance angiography and neuromonitoring to assess Spinal Cord blood supply in thoracic and thoracoabdominal aortic aneurysm surgery
Journal of Vascular Surgery, 2007Co-Authors: Robbert J Nijenhuis, G W H Schurink, M J Jacobs, A G H Kessels, Jos M A Van Engelshoven, Walter H BackesAbstract:Objective Preoperative knowledge of the blood-supplying trajectory to the Spinal Cord is of interest, because Spinal Cord ischemia may occur during thoracic aortic aneurysm (TAA) and thoracoabdominal aortic aneurysm (TAAA) repair and possibly leads to paraplegia. The Adamkiewicz artery (AKA) is considered to be the most important blood supplier of the thoracolumbar Spinal Cord and has therefore been the focus in preoperative diagnostic imaging. However, in TAA(A) patients, the blood supply to the Spinal Cord may strongly depend on (intersegmental) collateral circulation, because many segmental arteries are occluded as a result of atherosclerosis. Therefore, the importance of preserving the segmental artery supplying the AKA (SA-AKA) is debated. Here it was investigated whether (1) the AKA and its segmental supplier can be imaged by using magnetic resonance (MR) angiography and (2) aortic cross-clamping of the SA-AKA influences intraoperative Spinal Cord Function, monitored by motor evoked potentials (MEPs). Methods Preoperative MR angiography was performed to localize the SA-AKA and the AKA in 60 patients (19 TAA, 7 TAAA I, 18 TAAA II, 9 TAAA III, and 7 TAAA IV). Spinal Cord Function was monitored during surgery by using MEPs. When MEPs indicated critical ischemia, the SA-AKA was selectively reattached. To test whether aortic cross-clamping of the SA-AKA was associated with MEP decline, the Fisher statistical exactness test was applied. Results The AKA and SA-AKA could be localized in all 60 (100%) patients between vertebral levels T8 and L2 (72% left sided). In 44 (73%) patients, the SA-AKA was cross-clamped, which led in 32% (14/44) of cases to MEP decline. Reattachment of the preoperatively localized SA-AKA re-established MEPs and, thus, Spinal Cord Function in 12 of 14 cases. When the SA-AKA was outside the area cross-clamped, the MEPs always remained stable. A significant association ( P Conclusions The AKA can be localized before surgery in 100% of TAA(A) patients by using MR angiography. Location of the SA-AKA outside the cross-clamped aortic area is attended with stable MEPs. Interestingly, it was found that in most patients in whom the SA-AKA was cross-clamped, MEPs were not affected, thus indicating sufficient collateral blood supply to maintain Spinal Cord integrity. Nevertheless, preoperative knowledge of SA-AKA location is of importance, because in 32% of patients, Spinal Cord Function was dependent on this supplier. Revascularization of the SA-AKA can thereby reverse Spinal Cord dysFunction.
Walter H Backes - One of the best experts on this subject based on the ideXlab platform.
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magnetic resonance angiography of collateral blood supply to Spinal Cord in thoracic and thoracoabdominal aortic aneurysm patients
Journal of Vascular Surgery, 2008Co-Authors: Walter H Backes, G W H Schurink, W Mess, M J Jacobs, Robbert J Nijenhuis, Freke A WilminkAbstract:Objective Preservation of Spinal Cord blood supply during descending thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) surgery is mandatory to prevent neurologic complications. Although collateral arteries have been identified occasionally and are considered crucial for maintaining Spinal Cord Function in the individual patient, their critical Functionality is poorly understood and very little experience exists with visualization. This study investigated whether the preoperative and postoperative presence or absence of collateral arteries detected by magnetic resonance angiography (MRA) is related to Spinal Cord Function during the intraoperative exclusion of the segmental supply to the Adamkiewicz artery. Methods Spinal Cord MRA was used to localize the Adamkiewicz artery and its segmental supplier in 85 patients scheduled for open elective surgery for TAA or TAAA. The segmental artery to the Adamkiewicz artery was inside the cross-clamped aortic area in 55 patients, and Spinal Cord supply was consequently dependent on collateral supply. In these 55 patients the presence of collaterals originating from arteries outside the cross-clamped aortic segment was related to changes in the intraoperative motor-evoked potentials (MEPs) that occurred before corrective measures. Twenty-one patients returned for postoperative MRA. Results A highly significant ( P Conclusion Collateral arteries supplying the Spinal Cord can be systematically visualized using MRA. Spinal Cord blood supply during open aortic surgery may crucially depend on collateral arteries. Preoperatively identified collateral supply was 97% predictive for stable intraoperative Spinal Cord Function. Patients in whom no collaterals can be depicted preoperatively are at increased risk for Spinal Cord dysFunction.
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magnetic resonance angiography and neuromonitoring to assess Spinal Cord blood supply in thoracic and thoracoabdominal aortic aneurysm surgery
Journal of Vascular Surgery, 2007Co-Authors: Robbert J Nijenhuis, G W H Schurink, M J Jacobs, A G H Kessels, Jos M A Van Engelshoven, Walter H BackesAbstract:Objective Preoperative knowledge of the blood-supplying trajectory to the Spinal Cord is of interest, because Spinal Cord ischemia may occur during thoracic aortic aneurysm (TAA) and thoracoabdominal aortic aneurysm (TAAA) repair and possibly leads to paraplegia. The Adamkiewicz artery (AKA) is considered to be the most important blood supplier of the thoracolumbar Spinal Cord and has therefore been the focus in preoperative diagnostic imaging. However, in TAA(A) patients, the blood supply to the Spinal Cord may strongly depend on (intersegmental) collateral circulation, because many segmental arteries are occluded as a result of atherosclerosis. Therefore, the importance of preserving the segmental artery supplying the AKA (SA-AKA) is debated. Here it was investigated whether (1) the AKA and its segmental supplier can be imaged by using magnetic resonance (MR) angiography and (2) aortic cross-clamping of the SA-AKA influences intraoperative Spinal Cord Function, monitored by motor evoked potentials (MEPs). Methods Preoperative MR angiography was performed to localize the SA-AKA and the AKA in 60 patients (19 TAA, 7 TAAA I, 18 TAAA II, 9 TAAA III, and 7 TAAA IV). Spinal Cord Function was monitored during surgery by using MEPs. When MEPs indicated critical ischemia, the SA-AKA was selectively reattached. To test whether aortic cross-clamping of the SA-AKA was associated with MEP decline, the Fisher statistical exactness test was applied. Results The AKA and SA-AKA could be localized in all 60 (100%) patients between vertebral levels T8 and L2 (72% left sided). In 44 (73%) patients, the SA-AKA was cross-clamped, which led in 32% (14/44) of cases to MEP decline. Reattachment of the preoperatively localized SA-AKA re-established MEPs and, thus, Spinal Cord Function in 12 of 14 cases. When the SA-AKA was outside the area cross-clamped, the MEPs always remained stable. A significant association ( P Conclusions The AKA can be localized before surgery in 100% of TAA(A) patients by using MR angiography. Location of the SA-AKA outside the cross-clamped aortic area is attended with stable MEPs. Interestingly, it was found that in most patients in whom the SA-AKA was cross-clamped, MEPs were not affected, thus indicating sufficient collateral blood supply to maintain Spinal Cord integrity. Nevertheless, preoperative knowledge of SA-AKA location is of importance, because in 32% of patients, Spinal Cord Function was dependent on this supplier. Revascularization of the SA-AKA can thereby reverse Spinal Cord dysFunction.
Robbert J Nijenhuis - One of the best experts on this subject based on the ideXlab platform.
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magnetic resonance angiography of collateral blood supply to Spinal Cord in thoracic and thoracoabdominal aortic aneurysm patients
Journal of Vascular Surgery, 2008Co-Authors: Walter H Backes, G W H Schurink, W Mess, M J Jacobs, Robbert J Nijenhuis, Freke A WilminkAbstract:Objective Preservation of Spinal Cord blood supply during descending thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) surgery is mandatory to prevent neurologic complications. Although collateral arteries have been identified occasionally and are considered crucial for maintaining Spinal Cord Function in the individual patient, their critical Functionality is poorly understood and very little experience exists with visualization. This study investigated whether the preoperative and postoperative presence or absence of collateral arteries detected by magnetic resonance angiography (MRA) is related to Spinal Cord Function during the intraoperative exclusion of the segmental supply to the Adamkiewicz artery. Methods Spinal Cord MRA was used to localize the Adamkiewicz artery and its segmental supplier in 85 patients scheduled for open elective surgery for TAA or TAAA. The segmental artery to the Adamkiewicz artery was inside the cross-clamped aortic area in 55 patients, and Spinal Cord supply was consequently dependent on collateral supply. In these 55 patients the presence of collaterals originating from arteries outside the cross-clamped aortic segment was related to changes in the intraoperative motor-evoked potentials (MEPs) that occurred before corrective measures. Twenty-one patients returned for postoperative MRA. Results A highly significant ( P Conclusion Collateral arteries supplying the Spinal Cord can be systematically visualized using MRA. Spinal Cord blood supply during open aortic surgery may crucially depend on collateral arteries. Preoperatively identified collateral supply was 97% predictive for stable intraoperative Spinal Cord Function. Patients in whom no collaterals can be depicted preoperatively are at increased risk for Spinal Cord dysFunction.
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magnetic resonance angiography and neuromonitoring to assess Spinal Cord blood supply in thoracic and thoracoabdominal aortic aneurysm surgery
Journal of Vascular Surgery, 2007Co-Authors: Robbert J Nijenhuis, G W H Schurink, M J Jacobs, A G H Kessels, Jos M A Van Engelshoven, Walter H BackesAbstract:Objective Preoperative knowledge of the blood-supplying trajectory to the Spinal Cord is of interest, because Spinal Cord ischemia may occur during thoracic aortic aneurysm (TAA) and thoracoabdominal aortic aneurysm (TAAA) repair and possibly leads to paraplegia. The Adamkiewicz artery (AKA) is considered to be the most important blood supplier of the thoracolumbar Spinal Cord and has therefore been the focus in preoperative diagnostic imaging. However, in TAA(A) patients, the blood supply to the Spinal Cord may strongly depend on (intersegmental) collateral circulation, because many segmental arteries are occluded as a result of atherosclerosis. Therefore, the importance of preserving the segmental artery supplying the AKA (SA-AKA) is debated. Here it was investigated whether (1) the AKA and its segmental supplier can be imaged by using magnetic resonance (MR) angiography and (2) aortic cross-clamping of the SA-AKA influences intraoperative Spinal Cord Function, monitored by motor evoked potentials (MEPs). Methods Preoperative MR angiography was performed to localize the SA-AKA and the AKA in 60 patients (19 TAA, 7 TAAA I, 18 TAAA II, 9 TAAA III, and 7 TAAA IV). Spinal Cord Function was monitored during surgery by using MEPs. When MEPs indicated critical ischemia, the SA-AKA was selectively reattached. To test whether aortic cross-clamping of the SA-AKA was associated with MEP decline, the Fisher statistical exactness test was applied. Results The AKA and SA-AKA could be localized in all 60 (100%) patients between vertebral levels T8 and L2 (72% left sided). In 44 (73%) patients, the SA-AKA was cross-clamped, which led in 32% (14/44) of cases to MEP decline. Reattachment of the preoperatively localized SA-AKA re-established MEPs and, thus, Spinal Cord Function in 12 of 14 cases. When the SA-AKA was outside the area cross-clamped, the MEPs always remained stable. A significant association ( P Conclusions The AKA can be localized before surgery in 100% of TAA(A) patients by using MR angiography. Location of the SA-AKA outside the cross-clamped aortic area is attended with stable MEPs. Interestingly, it was found that in most patients in whom the SA-AKA was cross-clamped, MEPs were not affected, thus indicating sufficient collateral blood supply to maintain Spinal Cord integrity. Nevertheless, preoperative knowledge of SA-AKA location is of importance, because in 32% of patients, Spinal Cord Function was dependent on this supplier. Revascularization of the SA-AKA can thereby reverse Spinal Cord dysFunction.
W Mess - One of the best experts on this subject based on the ideXlab platform.
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Monitoring Spinal Cord Function in Open and Endovascular Treatment of Thoracoabdominal Aortic Pathologies
Surgical Management of Aortic Pathology, 2019Co-Authors: Barend Mees, G W H Schurink, W Mess, Noud Peppelenbosch, M J JacobsAbstract:Spinal Cord ischemia is one of the most dreadful complications of thoracic and thoracoabdominal aortic surgery. The complex mechanisms of Spinal Cord perfusion under iatrogenic circumstances, such as surgery, are still not fully unraveled. Neuromonitoring during open and endovascular aortic surgery aims at assessing perioperative Spinal Cord Function, allowing corrective measures in case of compromised Spinal Cord perfusion and thus reducing the incidence of postoperative Spinal Cord ischemia. The technique of motor evoked potentials is a reliable and highly accurate method to evaluate Spinal Cord integrity during thoracic and thoracoabdominal aortic repair.
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Spinal Cord Function monitoring during endovascular treatment of thoracoabdominal aneurysms: implications for staged procedures.
Journal of Cardiovascular Surgery, 2013Co-Authors: G W H Schurink, M W De Haan, A G Peppelenbosch, W Mess, M J JacobsAbstract:Aim Spinal Cord ischemia is a well-known complication in the treatment of thoracoabdominal aneurysms (TAAA). Despite the fact that endovascular treatment of TAAA is less invasive, Spinal Cord ischemia rate is not reduced if compared to open repair. Methods We report the results of our experience of Spinal Cord Function monitoring by measuring motor evoked potentials (MEP) during endovascular treatment of TAAA type II and III. Depending on the level of the MEPs the decision is made whether to stage the procedure or not. We treated ten patients acCording to this protocol. Results In two patients, MEPs decreased 50% or more and procedures were staged. Both experienced no neurological complications after first and second procedure. No MEPs decrease was seen during the second procedures. One of the other eight patients had a temporary right lower leg pararesis. Conclusion In conclusion we state that our first experience demonstrates the value of assessing Spinal Cord Function during extensive endovascular TAAA repair with subsequent strategies to prevent paraplegia.
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Spinal Cord Function monitoring during endovascular treatment of thoracoabdominal aneurysms: implications for staged procedures.
The Journal of cardiovascular surgery, 2013Co-Authors: G W H Schurink, M W De Haan, A G Peppelenbosch, W Mess, M J JacobsAbstract:Spinal Cord ischemia is a well-known complication in the treatment of thoracoabdominal aneurysms (TAAA). Despite the fact that endovascular treatment of TAAA is less invasive, Spinal Cord ischemia rate is not reduced if compared to open repair. We report the results of our experience of Spinal Cord Function monitoring by measuring motor evoked potentials (MEP) during endovascular treatment of TAAA type II and III. Depending on the level of the MEPs the decision is made whether to stage the procedure or not. We treated ten patients acCording to this protocol. In two patients, MEPs decreased 50% or more and procedures were staged. Both experienced no neurological complications after first and second procedure. No MEPs decrease was seen during the second procedures. One of the other eight patients had a temporary right lower leg pararesis. In conclusion we state that our first experience demonstrates the value of assessing Spinal Cord Function during extensive endovascular TAAA repair with subsequent strategies to prevent paraplegia.
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Neurological Monitoring with Evoked Potentials
Thoraco-Abdominal Aorta, 2011Co-Authors: M J Jacobs, W MessAbstract:The aim of perioperative neurological monitoring is to assess Spinal Cord Function during aortic cross-clamping, allowing corrective measures in case of jeopardized Spinal Cord perfusion. The technique of motor evoked potentials is a reliable and highly sensitive method to evaluate Spinal Cord integrity during thoraco-abdominal aortic repair. Using this technique, critical Spinal Cord Function can be determined and improved by surgical and hemodynamic interactions in order to prevent neurological deficits.
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magnetic resonance angiography of collateral blood supply to Spinal Cord in thoracic and thoracoabdominal aortic aneurysm patients
Journal of Vascular Surgery, 2008Co-Authors: Walter H Backes, G W H Schurink, W Mess, M J Jacobs, Robbert J Nijenhuis, Freke A WilminkAbstract:Objective Preservation of Spinal Cord blood supply during descending thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) surgery is mandatory to prevent neurologic complications. Although collateral arteries have been identified occasionally and are considered crucial for maintaining Spinal Cord Function in the individual patient, their critical Functionality is poorly understood and very little experience exists with visualization. This study investigated whether the preoperative and postoperative presence or absence of collateral arteries detected by magnetic resonance angiography (MRA) is related to Spinal Cord Function during the intraoperative exclusion of the segmental supply to the Adamkiewicz artery. Methods Spinal Cord MRA was used to localize the Adamkiewicz artery and its segmental supplier in 85 patients scheduled for open elective surgery for TAA or TAAA. The segmental artery to the Adamkiewicz artery was inside the cross-clamped aortic area in 55 patients, and Spinal Cord supply was consequently dependent on collateral supply. In these 55 patients the presence of collaterals originating from arteries outside the cross-clamped aortic segment was related to changes in the intraoperative motor-evoked potentials (MEPs) that occurred before corrective measures. Twenty-one patients returned for postoperative MRA. Results A highly significant ( P Conclusion Collateral arteries supplying the Spinal Cord can be systematically visualized using MRA. Spinal Cord blood supply during open aortic surgery may crucially depend on collateral arteries. Preoperatively identified collateral supply was 97% predictive for stable intraoperative Spinal Cord Function. Patients in whom no collaterals can be depicted preoperatively are at increased risk for Spinal Cord dysFunction.