North R B, Drenger B, Beattie C, McPherson R W, Parker S, Reitz B A, Williams G M
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Neurosurgery. 1991 Feb;28(2):325-30. doi: 10.1097/00006123-199102000-00027.
Repair of a thoracoabdominal aneurysm involves a significant risk of ischemic injury to the spinal cord. Standard monitoring of somatosensory evoked potentials, which relies upon peripheral nerve stimulation, becomes nonspecific and insensitive during this surgery when aortic cross-clamping produces lower extremity ischemia causing a peripheral conduction block. Techniques for the insertion of percutaneous epidural electrodes, developed originally for pain management, have been adapted to this setting to permit direct stimulation of the spinal cord for intraoperative monitoring of evoked potentials. The clinical outcome in patients monitored by this technique has been consistent with evoked potential findings.
胸腹主动脉瘤修复术存在脊髓缺血性损伤的重大风险。标准的体感诱发电位监测依赖于外周神经刺激，在该手术过程中，当主动脉交叉钳夹导致下肢缺血引起外周传导阻滞时，这种监测就变得非特异性且不敏感。最初为疼痛管理而开发的经皮硬膜外电极插入技术已被应用于这种情况，以允许直接刺激脊髓进行术中诱发电位监测。通过该技术监测的患者的临床结果与诱发电位结果一致。
