Kerkhof Fabian I, van Schaik Jan, Massaad Richard A, van Rijswijk Catharina S P, Tannemaat Martijn R
Department of Neurology, Leiden University Medical Center, the Netherlands.
Department of Surgery, Leiden University Medical Center, the Netherlands.
Clin Neurophysiol Pract. 2020 Dec 11;6:16-21. doi: 10.1016/j.cnp.2020.11.002. eCollection 2021.
Spinal cord injury is a devastating complication after endovascular thoracic and thoracoabdominal aneurysm repair (EVAR). Motor evoked potentials (MEPs) can be monitored to detect spinal cord injury, but may also be affected by peripheral ischemia caused by femoral artery sheaths. We aimed to determine the incidence of peripheral ischemia during EVAR, and whether central and peripheral ischemia can be distinguished using compound muscle action potentials (CMAPs).
We retrospectively analyzed all EVAR procedures between March 1st 2015 and January 1st 2020 during which MEPs were monitored. Peripheral ischemia was defined as both a reduction in MEP amplitudes reversed by removing the femoral sheaths and no clinical signs of immediate post-procedural paraparesis. All other MEP decreases were defined as central ischemia.
A significant MEP decrease occurred in 14/27 (52%) of all procedures. Simultaneous CMAP amplitude reduction was observed in 7/8 (88%) of procedures where peripheral ischemia occurred, and never in procedures with central ischemia.
MEP reductions due to peripheral ischemia are common during EVAR. A MEP-reduction without a CMAP decrease indicates central ischemia.
CMAP measurements can help to distinguish central from peripheral ischemia, potentially reducing the chance of misinterpreting of MEP amplitude declines as centrally mediated, without affecting sensitivity.
脊髓损伤是胸段及胸腹段动脉瘤腔内修复术（EVAR）后一种严重的并发症。可通过监测运动诱发电位（MEP）来检测脊髓损伤，但MEP也可能受股动脉鞘管导致的外周缺血影响。我们旨在确定EVAR期间外周缺血的发生率，以及能否使用复合肌肉动作电位（CMAP）区分中枢性和外周性缺血。
我们回顾性分析了2015年3月1日至2020年1月1日期间所有监测MEP的EVAR手术。外周缺血定义为移除股动脉鞘管后MEP波幅降低且术后无立即出现的双下肢轻瘫临床体征。所有其他MEP降低定义为中枢性缺血。
所有手术中有14/27（52%）出现显著的MEP降低。在发生外周缺血的手术中，7/8（88%）观察到同时出现CMAP波幅降低，而在中枢性缺血的手术中从未观察到。
EVAR期间因外周缺血导致的MEP降低很常见。MEP降低而CMAP未降低提示中枢性缺血。
CMAP测量有助于区分中枢性和外周性缺血，可能减少将MEP波幅下降误判为中枢介导的情况，且不影响敏感性。
