Surgical treatment of thoracoabdominal aortic aneurysm: detection and prevention of spinal cord injury

Five cases with thoracoabdominal aneurysm underwent surgical treatment under the monitoring of somatosensory evoked potentials (SEP) and spinal cord perfusion pressure [SCPP, the pressure difference between mean distal aortic pressure (MDAP) and cerebrospinal fluid pressure CSFP)]. The reconstruction of major branches of abdominal aorta and intercostal arteries were also performed. The surgical results and data of SEP, CSFP and SCPP during the cross-clamping were reported. Our procedures to detect and prevent ischemic spinal cord injury based on the experiments performed in our department were also summarized as follows: (1) Segmental cross-clamping should be applied during the reconstruction of thoracoabdominal aorta. (2) Major intercostal or lumbar arteries should be reconstructed. (3) SEP should be monitored to detect the spinal cord ischemia. (4) SCPP should be maintained at more than 40 mmHg by increasing MDAP and/or decreasing CSFP.