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Paraspinale Nahinfrarotspektroskopie zur indirekten Überwachung der Rückenmarkoxygenierung

Experimentelle und klinische Daten

Indirect monitoring of spinal cord oxygenation by paraspinal near-infrared spectroscopy

Experimental and clinical data

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Zusammenfassung

In der Therapie des thorakoabdominellen Aortenaneurysmas konkurriert der offen-chirurgische Ersatz zunehmend mit der endovaskulären Stentgraftimplantation. Die schwerwiegendste Komplikation beider Verfahren ist der ischämische Rückenmarkschaden, der oft eine permanente Paraplegie nach sich zieht. Methoden zur nichtinvasiven Echtzeitüberwachung der Rückenmarkperfusion während und nach ausgedehnten Eingriffen an der Aorta sind im klinischen Alltag nicht etabliert. Die nichtinvasive Methode der Kollateralnetzwerk-Nahinfrarotspektroskopie (cnNIRS) soll peri- und postoperativ Rückschlüsse auf die Rückenmarkoxygenierung in Echtzeit ermöglichen. Experimentelle und klinische Studien konnten zeigen, dass die lumbale cnNIRS direkt proportional und unmittelbar auf eine Ischämie und Reperfusion nach Aortenklemmung und distaler Perfusion reagierten. Die hochthorakale Optodenplatzierung hingegen zeigte keine relevanten Änderungen und scheint daher aktuell klinisch nicht sinnvoll. Lumbales cnNIRS ist technisch einfach anzuwenden. Es konnte ein Zusammenhang zwischen reduzierten Werten und einem schlechteren postoperativen Ergebnis hinsichtlich Paraplegie und -parese nach Eingriffen an der thorakoabdominellen Aorta gezeigt werden. Die maximale Reduktion der Messgröße, angegeben in Prozent des individuellen Ausgangswerts, beträgt 25 bis 35 %. Für die endovaskuläre Therapie konnten bislang keine signifikanten Änderungen nachgewiesen werden und zurzeit existieren noch keine ausreichenden Daten, um verlässliche cnNIRS-Referenzbereiche aufzuzeigen. Lumbales cnNIRS ist klinisch nutzbar und eine vielversprechende Methode zur Echtzeitüberwachung der spinalen Oxygenierung während und nach Operationen an der thorakoabdominellen Aorta. Eine Klärung, ob und inwieweit cnNIRS-Änderungen während der endovaskulären Therapie abbildet, steht derzeit noch aus.

Abstract

Thoracoabdominal aortic aneurysm repair can be performed by an open surgical approach and by endovascular stent graft implantation. The most devastating complication is ischemic spinal cord injury, which can occur in both procedures and often results in permanent paraplegia. Methods for non-invasive real-time monitoring of spinal cord perfusion during and after extensive aortic repair are not routinely used in current clinical practice. The new method of collateral network near infrared spectroscopy (cnNIRS) is a non-invasive modality to enable real-time perioperative and postoperative monitoring of spinal cord oxygenation. Experimental and clinical studies have shown that lumbar cnNIRS immediately reacts to ischemia and reperfusion after aortic cross-clamping and during distal perfusion. Optode placement at the upper thoracic level did not show any relevant changes and therefore does not currently appear to be clinically useful. Lumbar cnNIRS is technically simple to use and it has been demonstrated that reduced lumbar cnNIRS values correlate with a worse postoperative outcome regarding paraplegia and paraparesis after open thoracoabdominal aortic repair. The maximum reduction expressed as a percentage of the individual baseline value ranges from 25% to 35%. To date no significant changes were detected for endovascular aortic repair. Sufficient data demonstrating reliable cnNIRS reference values and ranges are needed. Nevertheless, lumbar cnNIRS is clinically feasible and a promising method for non-invasive real-time monitoring of spinal cord oxygenation during and after open thoracoabdominal aortic repair. Further clinical and experimental studies are necessary to clarify whether and to what extent cnNIRS can depict changes during endovascular aortic interventions.

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Authors and Affiliations

  1. Abteilung für Herz- und Thoraxchirurgie, Herzzentrum Universität Leipzig, Struempellstrasse 39, 04289, Leipzig, Deutschland

    K. von Aspern, F. Bakhtiary, M. Misfeld, F. W. Mohr & C. D. Etz

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  1. K. von Aspern
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  2. F. Bakhtiary
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  3. M. Misfeld
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Correspondence to K. von Aspern.

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K. von Aspern und C.D. Etz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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von Aspern, K., Bakhtiary, F., Misfeld, M. et al. Paraspinale Nahinfrarotspektroskopie zur indirekten Überwachung der Rückenmarkoxygenierung. Gefässchirurgie 22, 102–109 (2017). https://doi.org/10.1007/s00772-017-0244-0

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