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ID 38667
file
title alternative
運動誘発電位監視下での胸部大動脈手術における冷却血液による脊髄保護
creator
NDC
Medical sciences
abstract
Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.
language
eng
nii type
Thesis or Dissertation
HU type
Doctoral Theses
DCMI type
text
format
application/pdf
relation references
Shinya Takahashi, Kazumasa Orihashi, Katsuhiko Imai, Taketomo Mizukami, Taiichi Takasaki, and Taijiro Sueda; Cold blood spinoplegia under motor-evoked potential monitoring during thoracic aortic surgery; Journal of Thoracic and Cardiovascular Surgery, Volume 141, Issue 3, March 2011, Pages 755-761 (doi: 10.1016/j.jtcvs.2010.09.056)
relation references URL
http://doi.org/10.1016/j.jtcvs.2010.09.056
grantid
甲第5375号
degreeGrantor
広島大学(Hiroshima University)
degreename Ja
博士(医学)
degreelevel
doctoral
date of granted
2011-01-27
department
Graduate School of Biomedical Science
University Medical Hospital