Weigang Ernst, Hartert Marc, Siegenthaler Michael P, Beckmann Nicholas A, Sircar Ronen, Szabò Gàbor, Etz Christian D, Luehr Maximilian, von Samson Patrick, Beyersdorf Friedhelm
Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany.
Ann Thorac Surg. 2006 Nov;82(5):1679-87. doi: 10.1016/j.athoracsur.2006.05.037.
Thoracic or thoracoabdominal aortic stent-graft repair has shown a reduction in morbidity and mortality rates due to the procedure's advantages (no aortic cross-clamping, continuous distal aortic perfusion, no reperfusion injury). However, 3% to 12% of the patients are at risk of spinal cord ischemia. We investigated spinal cord protective measures with evoked potentials, cerebrospinal fluid drainage, and prevention of hypotension to minimize postoperative neurologic deficit.
Between November 2000 and July 2005, vital parameters and spinal cord function were monitored, including cerebrospinal fluid pressure and transcranial motor-evoked and somatosensory-evoked potentials in 36 stent-graft procedures (31 patients) on the thoracic or thoracoabdominal aorta.
Stent-graft placement was technically successful in all patients. We achieved a survival rate of 100% without neurologic deficit after fast-track extubation. Eleven of 31 patients exhibited changes in evoked potentials during stent-graft deployment. In 12 of 31 patients (including the 11 with evoked potential alterations), cerebrospinal fluid pressure exceeded 15 mm Hg. Cerebrospinal fluid drainage and vital parameter adjustment were executed in those instances. We observed intraoperative evoked potential total recovery in 10 of 11 patients after these interventions.
Interventions to improve spinal cord perfusion led to total recovery of spinal function in most patients (10/11). Therefore, spinal cord protective measures with motor- and somatosensory-evoked potential monitoring, cerebrospinal fluid drainage, and prevention of hypotension can reduce the incidence of spinal cord ischemia and improve the neurologic outcome of patients undergoing endovascular thoracic or thoracoabdominal aortic repair.
胸主动脉或胸腹主动脉支架移植物修复术因其优势（无需主动脉交叉钳夹、持续主动脉远端灌注、无再灌注损伤）已显示出发病率和死亡率降低。然而，3%至12%的患者有脊髓缺血风险。我们研究了通过诱发电位、脑脊液引流和预防低血压等脊髓保护措施，以尽量减少术后神经功能缺损。
在2000年11月至2005年7月期间，对36例胸主动脉或胸腹主动脉支架移植物手术（31例患者）的生命体征参数和脊髓功能进行了监测，包括脑脊液压力以及经颅运动诱发电位和体感诱发电位。
所有患者的支架移植物置入在技术上均获成功。快速拔管后，我们实现了100%的生存率且无神经功能缺损。31例患者中有11例在支架移植物置入过程中诱发电位出现变化。31例患者中有12例（包括11例诱发电位改变的患者）脑脊液压力超过15 mmHg。在这些情况下进行了脑脊液引流和生命体征参数调整。经过这些干预后，我们观察到11例患者中有10例术中诱发电位完全恢复。
改善脊髓灌注的干预措施使大多数患者（10/11）的脊髓功能完全恢复。因此，通过运动和体感诱发电位监测、脑脊液引流以及预防低血压等脊髓保护措施，可以降低脊髓缺血的发生率，并改善接受胸主动脉或胸腹主动脉血管腔内修复术患者的神经功能结局。
