Selective intercostal arterial perfusion during thoracoabdominal aortic aneurysm surgery

Background. This clinical study evaluated changes in motor evoked potentials (MEP) elicited by direct cerebral cortical stimulation and evoked spinal cord potentials (ESCPs) elicited by direct spinal cord stimulation during selective intercostal arterial perfusion for thoracoabdominal aortic aneurysm (TAAA) repair. We also determined the efficacy of this perfusion method for prevention of paraplegia. Methods. Two kinds of ESCPs and MEPs were monitored during the prosthetic replacement step for TAAA surgeries. We performed selective intercostal arterial perfusion from the T7 intercostal artery to the L1 intercostal artery through a small piece of Dacron graft while monitoring spinal cord potentials in five cases of TAAA. Results. The MEP amplitude decreased after clamping the aorta but quickly recovered after selective perfusion of intercostal arteries. Other spinal cord potentials did not change during the reconstruction of intercostal arteries. Postoperative paraplegia or parapalesis did not occur in any of the patients. Conclusions. Monitoring of MEPs during selective intercostal arterial perfusion was a useful adjunct to prevent postoperative paraplegia in TAAA surgery.