Sage Journals: Discover world-class research

Abstract

Background:

In this study, gas tensions in cerebrospinal fluid (CSF) were prospectively evaluated as intraoperative markers for the detection of neurological deficits.

Methods:

Spinal fluid, serum, and heart lung machine (HLM) perfusate were monitored for gas tensions (po ₂/pCo ₂) and related parameters (pH, lactate, and glucose) during thoracoabdominal aortic repair and correlated with perioperative neurological examination and electrophysiological testing.

Results:

Forty-seven patients were assessed for the study, and 40 consecutive patients were finally included. The patients were divided into 3 groups: group A (23 patients, 57.5%): no clinical or laboratory signs of neurological damage; group B (14 patients, 35%) who developed subclinical deficits; and group C (3 patients, 7.5%) who had paraplegia. Significant intraoperative changes in CSF gas tensions were observed with postoperative paraplegia. Glucose ratio between serum and CSF showed higher variability in group C, confirming a damage of the blood–brain barrier (BBB).

Conclusion:

Major neurological damage is reflected by early changes in CSF gas tensions and glucose variability, suggesting damage of the BBB in these patients.

Keywords

thoracoabdominal aortic repair CSF drainage paraplegia

Get full access to this article

View all access options for this article.

References

Bisdas

Redwan

Wilhelmi

. Less-invasive perfusion techniques may improve outcome in thoracoabdominal aortic surgery. J Thorac Cardiovasc Surg. 2010;140(6):1319–1324.

Coselli

Bozinovski

LeMaire

. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2007;83(2):862–864.

Jacobs

de Mol

Elenbaas

. Spinal cord blood supply in patients with thoracoabdominal aortic aneurysms. J Vasc Surg. 2002;35(1):30–37.

Jacobs

Meylaerts

de Mol

Kalkman

. Strategies to prevent neurologic deficit based on motor-evoked potentials in type I and II thoracoabdominal aortic aneurysm repair. J Vasc Surg. 1999;29(1):48–57.

Crawford

Svensson

Hess

. A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg. 1991;13(1):36–45.

Etz

Luehr

Kari

. Paraplegia after extensive thoracic and thoracoabdominal aortic aneurysm repair: does critical spinal cord ischemia occur postoperatively? J Thorac Cardiovasc Surg. 2008;135(2):324–330.

Etz

Homann

Plestis

. Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented? Eur J Cardiothorac Surg. 2007;31(4):643–648.

Khaladj

Teebken

Hagl

. The role of cerebrospinal fluid S100 and lactate to predict clinically evident spinal cord ischaemia in thoraco-abdominal aortic surgery. Eur J Vasc Endovasc Surg. 2008;36(1):11–19.

van Dongen

ter Beek

Schepens

. The relationship between evoked potentials and measurements of S-100 protein in cerebrospinal fluid during and after thoracoabdominal aortic aneurysm surgery. J Vasc Surg. 1999;30(2):293–300.

10.

Coselli

Tsai

. Motor evoked potentials in thoracoabdominal aortic surgery: CON. Cardiol Clin. 2010;28(2):361–368.

11.

Crawford

Mizrahi

Hess

Coselli

Safi

Patel

. The impact of distal aortic perfusion and somatosensory evoked potential monitoring on prevention of paraplegia after aortic aneurysm operation. J Thorac Cardiovasc Surg. 1988;95(3):357–367.

12.

Gugino

Kraus

Heino

. Peripheral ischemia as a complicating factor during somatosensory and motor evoked potential monitoring of aortic surgery. J Cardiothorac Vasc Anesth. 1992;6(6):715–719.

13.

Jacobs

Mess

Mochtar

Nijenhuis

Statius van Eps

Schurink

. The value of motor evoked potentials in reducing paraplegia during thoracoabdominal aneurysm repair. J Vasc Surg. 2006;43(2):239–246.

14.

Stadlbauer

Salomonowitz

van der

Buchfelder

Ganslandt

. Insight into the patterns of cerebrospinal fluid flow in the human ventricular system using MR velocity mapping. Neuroimage. 2010;51(1):42–52.

15.

Ballabh

Braun

Nedergaard

. The blood-brain barrier: an overview: structure, regulation, and clinical implications. Neurobiol Dis. 2004;16(1):1–13.

16.

Griepp

. Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept. Ann Thorac Surg. 2007;83(2):865–869.

17.

Sharpe

Dennis

Nasim

. Dual antiplatelet therapy prior to carotid endarterectomy reduces post-operative embolisation and thromboembolic events: post-operative transcranial Doppler monitoring is now unnecessary. Eur J Vasc Endovasc Surg. 2010;40(2):162–167.

18.

Fareed

Rothwell

Mehta

Naylor

. Synchronous carotid endarterectomy and off-pump coronary bypass: an updated, systematic review of early outcomes. Eur J Vasc Endovasc Surg. 2009;37(4):375–378.

19.

Kamiya

Klima

Hagl

. Cerebral microembolization during antegrade selective cerebral perfusion. Ann Thorac Surg. 2006;81(2):519–521.

20.

Ulus

Hellberg

Ulus

Karacagil

. Alterations in cerebrospinal fluid PO(2), PCO(2), and pH measurements during and after experimental thoracic aortic cross-clamping. Ann Vasc Surg. 2009;23(1):122–127. doi:10.1016/j.avsg.2008.06.004.

Intraoperative Changes in Cerebrospinal Fluid Gas Tensions Reflect Paraplegia During Thoracoabdominal Aortic Surgery

Abstract

Background:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References