Department of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Faculty of Medicine, Department of Surgery and Cancer, Imperial College London & Imperial College Healthcare NHS Trust, London, UK.
Eur J Cardiothorac Surg. 2023 Jun 1;63(6). doi: 10.1093/ejcts/ezad221.
While open surgical repair remains the gold standard for thoracoabdominal aortic aneurysm (TAAA) treatment, there is still no consensus regarding perioperative neuromonitoring technique for prevention of spinal cord ischaemia.
In this systematic review, we aimed to explore the effects and practices of neuromonitoring during the open TAAA repair. A systematic literature search in PubMed, Embase via Ovid, Cochrane library and ClinicalTrialsGov until December 2022 was performed.
A total of 535 studies were identified from the literature search, of which 27 studies including a total of 3130 patients met the eligibility criteria. Most studies (21 out of 27, 78%) investigated the feasibility of motor-evoked potentials (MEP), while 15 analysed somatosensory-evoked potentials (SSEP) and 2 studies analysed near-infrared spectroscopy during open TAAA repair.
Current literature suggest that rates of postoperative spinal cord ischaemia can be kept at low levels after open TAAA repair with the adequate precautions and perioperative manoeuvres. Neuromonitoring with MEP provides the surgeon objective criteria to direct selective intercostal reconstruction or other protective anaesthetic and surgical manoeuvres. Simultaneous monitoring of MEP and SSEP is a reliable method that can rapidly detect important findings and direct adequate protective manoeuvres during open TAAA repair.
虽然开放手术修复仍然是胸主动脉腹主动脉瘤（TAAA）治疗的金标准，但对于预防脊髓缺血的围手术期神经监测技术仍未达成共识。
在本次系统评价中，我们旨在探讨开放 TAAA 修复过程中神经监测的效果和实践。通过 PubMed、Embase via Ovid、Cochrane 图书馆和 ClinicalTrialsGov 进行了系统的文献检索，检索时间截至 2022 年 12 月。
从文献检索中总共确定了 535 项研究，其中 27 项研究（共 3130 名患者）符合纳入标准。大多数研究（27 项中的 21 项，78%）调查了运动诱发电位（MEP）的可行性，而 15 项分析了体感诱发电位（SSEP），2 项研究分析了开放 TAAA 修复过程中的近红外光谱。
目前的文献表明，在开放 TAAA 修复后，通过适当的预防措施和围手术期操作，可以将术后脊髓缺血的发生率保持在较低水平。MEP 神经监测为外科医生提供了客观的标准，以指导选择性肋间重建或其他保护麻醉和手术操作。MEP 和 SSEP 的同时监测是一种可靠的方法，可以在开放 TAAA 修复过程中快速检测到重要发现并指导适当的保护操作。
