Bassett G, Johnson C, Stanley P
Division of Orthopaedic Surgery, Childrens Hospital Los Angeles, California, USA.
Spine (Phila Pa 1976). 1996 Sep 1;21(17):1996-9; discussion 2000. doi: 10.1097/00007632-199609010-00012.
The results of preoperative selective spinal angiography were compared with intraoperative occlusion of segmental arteries and somatosensory-evoked potential monitoring during anterior spinal surgery.
To determine if temporary occlusion of major radicular vessels supplying the spinal cord would result in intraoperative somatosensory-evoked potential changes.
Temporary occlusion of segmental spinal arteries with concomitant somato-sensory-evoked potential monitoring has been used during anterior spinal surgery to avoid intraoperative vascular paraplegias caused by permanent ligations of vessels critical to the blood supply of the spinal cord.
Preoperative selective spinal angiography was performed in 16 patients to identify important radicular arteries supplying the spinal cord. At the time of anterior spinal surgery, temporary occlusion of segmental vessels was accomplished with somatosensory-evoked potential monitoring.
Thirty-two radicular arteries were identified by arteriography in 16 patients. Temporary occlusion of nine segmental arteries in the surgical field supplying these radicular vessels resulted in no somatosensory-evoked potential changes.
The lack of somatosensory-evoked potential changes after temporary occlusion of segmental arteries from which radicular arteries supply the spinal cord demonstrates sufficient perimedullary collateral circulation in that area of the spinal cord.
将术前选择性脊髓血管造影的结果与脊柱前路手术中节段动脉的术中阻断及体感诱发电位监测结果进行比较。
确定供应脊髓的主要神经根血管的临时阻断是否会导致术中体感诱发电位变化。
在脊柱前路手术中，已采用节段性脊髓动脉临时阻断并同时进行体感诱发电位监测，以避免因永久性结扎对脊髓血供至关重要的血管而导致术中血管性截瘫。
对16例患者进行术前选择性脊髓血管造影，以识别供应脊髓的重要神经根动脉。在脊柱前路手术时，通过体感诱发电位监测实现节段血管的临时阻断。
16例患者经动脉造影共识别出32条神经根动脉。手术视野中供应这些神经根血管的9条节段动脉的临时阻断未导致体感诱发电位变化。
供应脊髓的神经根动脉所在节段动脉临时阻断后体感诱发电位无变化，表明该脊髓区域存在足够的髓周侧支循环。
