[Monitoring for spinal cord ischemia by the use of the motor evoked potentials, the evoked spinal cord potential and the segmental evoked spinal cord potential during thoracoabdominal aortic surgery--a case report].

A 55-year-old woman, who was detected an enlargement of the aorta with body CT, was admitted to our hospital. Preoperative examination revealed that the aneurysm was expanded from ascending aorta to the abdominal aorta above the celiac artery. She underwent total arch replacement using elephant trunk technique. Forty-four days after operation, she underwent thoracoabdominal aortic replacement with monitoring for spinal cord ischemia by the use of the motor evoked potentials (MEP), the evoked spinal cord potential (ESCP) and the segmental evoked spinal cord potential (S-ESCP). Under the partial cardiopulmonary bypass with femoral venous drainage and femoral arterial cannulation on normothermia, the aneurysmal part of the aorta was segmentally cross-clamped and the three lumbar arteries and the celiac artery were reconstructed one by one. During the operation, the monitor showed no remarkable change, even while the aorta was cross clamped. Her postoperative course was uneventful without any spinal cord damage. Combined use of MEP, ESCP, and S-ESCP was useful for monitoring spinal cord injury during thoracoabdominal aneurysmal repair.