Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan.
J Thorac Cardiovasc Surg. 2011 Mar;141(3):755-61. doi: 10.1016/j.jtcvs.2010.09.056. Epub 2010 Nov 20.
Motor-evoked potential monitoring is used to prevent paraplegia during thoracic aortic surgery. Multidetector computed tomography has been used preoperatively to detect the Adamkiewicz artery, but the hemodynamic significance of the Adamkiewicz artery is controversial. This study aims to evaluate whether the multidetector computed tomography-defined Adamkiewicz artery is hemodynamically essential and needs to be reconstructed with cold blood spinoplegia under motor-evoked potential monitoring.
From 2005 to 2008, both preoperative multidetector computed tomographic analysis and intraoperative neurogenic motor-evoked potential monitoring with cold blood infusion into the clamped segment of the aorta were done in 15 patients. A motor-evoked potential decrease to less than 50% of the initial value at 3 minutes after cold blood infusion determined the hemodynamic significance of the multidetector computed tomography-defined Adamkiewicz artery. Adamkiewicz arteries determined to be essential were reconstructed, and those determined to be nonessential were sacrificed.
The Adamkiewicz artery was involved in the clamped segment of the aorta in 11 cases. After cold blood infusion, 8 patients experienced no significant motor-evoked potential decrease, and Adamkiewicz artery ligation was undertaken, whereas a moderate motor-evoked potential decrease was noted in 1 patient, prompting reconstruction. None of these 9 patients had permanent neurologic deficits. In 2 patients, the Adamkiewicz artery was reconstructed based on motor-evoked potential findings, with paraparesis occurring in 1 patient. In 4 patients without Adamkiewicz artery involvement in the clamped segment, there was no neurologic deficit.
Cold blood infusion accelerates motor-evoked potential changes and might enable decision making regarding the need for reconstruction of multidetector computed tomography-defined Adamkiewicz arteries. Cold blood-loaded motor-evoked potential is beneficial to minimize Adamkiewicz artery reconstruction time and limit spinal cord ischemia.
运动诱发电位监测用于预防胸主动脉手术中的截瘫。多排螺旋 CT 已用于术前检测 Adamkiewicz 动脉，但 Adamkiewicz 动脉的血流动力学意义存在争议。本研究旨在评估多排螺旋 CT 定义的 Adamkiewicz 动脉是否具有血流动力学意义，是否需要在运动诱发电位监测下用冷血自旋阻断重建。
2005 年至 2008 年，15 例患者均行术前多排螺旋 CT 分析和术中神经源性运动诱发电位监测，用冷血灌注夹闭段主动脉。冷血灌注 3 分钟后运动诱发电位降低至初始值的 50%以下，确定多排螺旋 CT 定义的 Adamkiewicz 动脉的血流动力学意义。确定为必需的 Adamkiewicz 动脉进行重建，确定为非必需的 Adamkiewicz 动脉进行牺牲。
11 例患者的 Adamkiewicz 动脉位于夹闭段主动脉内。冷血灌注后，8 例患者无明显运动诱发电位下降，行 Adamkiewicz 动脉结扎，1 例患者出现中度运动诱发电位下降，提示重建。这 9 例患者均无永久性神经功能缺损。2 例患者根据运动诱发电位结果重建 Adamkiewicz 动脉，其中 1 例出现截瘫。4 例夹闭段无 Adamkiewicz 动脉的患者无神经功能缺损。
冷血灌注加速运动诱发电位变化，有助于决定是否需要重建多排螺旋 CT 定义的 Adamkiewicz 动脉。冷血负荷运动诱发电位有助于最大限度地减少 Adamkiewicz 动脉重建时间，限制脊髓缺血。
