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European Spine Journal

, Volume 16, Issue 6, pp 787–793 | Cite as

Transcranial motor-evoked potentials monitoring can detect spinal cord ischemia more rapidly than spinal cord-evoked potentials monitoring during aortic occlusion in rats

  • Manabu Kakinohana
  • Seiya Nakamura
  • Tatsuya Fuchigami
  • Kazuhiro Sugahara
Original Article

Abstract

In this study, we evaluated the efficacy of transcranial motor-evoked potentials (tc-MEPs), compared with segmental spinal cord-evoked potentials (SCEPs), for detecting spinal cord ischemia (SCI) and assessed the relationship between neurological outcome and tc-MEPs or SCEPs in the rat aortic occlusion model. In the rats, SCI was induced by aortic occlusion for 10 min with a balloon catheter. At first, tc-MEPs (Group A: n = 6) or segmental SCEPs (Group B: n = 6) was recorded during SCI. Second, in using the quantal bioassay for the relationship between an interval of aortic occlusion and the probability of positive response in tc-MEPs or segmental SCEPs, the P50MEP and P50SCEP which represent the interval of aortic occlusion associated with 50% probability of assessment of ischemic spinal cord dysfunction by tc-MEP and SCEP were analyzed. The amplitude of tc-MEPs decreased significantly at 30 s and disappeared completely at 2 min after aortic occlusion. In Group B, it took about 6 min after aortic occlusion to diminish SCEP signal amplitude by approximately 50%. P50MEP obtained in the quantal analysis was 0.3 ± 0.1 min. P50SCEP was calculated as 6.2 ± 0.5 min that was significantly (P < 0.01) longer than P50MEP. Our data indicated that tc-MEP monitoring could detect the onset of SCI so rapidly in comparison with segmental SCEP monitoring, which could provide therapeutic windows in a surgical approach that includes spinal cord protection.

Keywords

Spinal cord ischemia Spinal cord monitoring Motor-evoked monitoring Sensory-evoked monitoring 

Notes

Acknowledgments

This study was performed under the support of the Grant-in-aid for Scientific Research from the Ministry of Education of Japan (No. 16591551, 17591479).

References

  1. 1.
    Adams DH, Van Geertruyden HH (1956) Neurologic complications of aortic surgery. Ann Surg 144:574–610PubMedCrossRefGoogle Scholar
  2. 2.
    Brown RH, Nash CL, Berilla JA, Amaddio MD (1984) Cortical evoked potential monitoring: a system for intraoperative monitoring of spinal cord function. Spine 9:256–261PubMedCrossRefGoogle Scholar
  3. 3.
    Coles JG, Wilson GJ, Sima AF, Klement P, Tait GA (1982) Intraoperative detection of spinal cord ischemia using somatosensory cortical evoked potentials during thoracic aortic occlusion. Ann Thorac Surg 34:299–306PubMedCrossRefGoogle Scholar
  4. 4.
    Crawford ES, Crawford JL, Safi HJ, Coselli JS, Hess KR, Brooks B, Norton HJ, Glaeser DH (1986) Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate- and long-term results of operations in 605 patients. J Vasc Surg 3:389–404PubMedCrossRefGoogle Scholar
  5. 5.
    Cunningham JN Jr, Laschinger JC, Merkin HA, Nathan IM, Colvin S, Ransohoff J, Spencer FC (1982) Measurement of spinalc cord ischemia during operations upon the thoracic aorta. Initial clinical experience. Ann Surg 196:285–296PubMedCrossRefGoogle Scholar
  6. 6.
    de Haan P, Kalkman CJ (2001) Spinal cord monitoring: somatosensory- and motor-evoked potentials. Anesth Clin North Am 19:923–945CrossRefGoogle Scholar
  7. 7.
    de Haan P, Kalkman CJ, de Mol BD, Ubags LH, Veldman DJ, Jacobs MJ (1997) Efficacy of transcranial motor-evoked myogenic potentials to detect spinal cord ischemia during operations for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg 113:87–100PubMedCrossRefGoogle Scholar
  8. 8.
    Elger CE, Speckmann EJ, Caspers H, Janzen RW (1977) Corticospinal connections in the rat. I. Monosynaptic and polysynaptic responses of cervical motorneurons to epicortical stimulation. Exp Brain Res 28:385–404PubMedCrossRefGoogle Scholar
  9. 9.
    Fehlings MG, Tator CH, Linden RD, Piper IR (1987) Motor evoked potentials recorded from normal and spinalo cord-injured rats. Neurosurgery 20:125–130PubMedCrossRefGoogle Scholar
  10. 10.
    Gharagozloo F, Neville RFJ, Cox JL (1998) Spinal cord protection during surgical procedures on the descending thoracic and thoracoabdominal aorta: a critical overview. Semin Thorac Cardiovasc Surg 10:73–86PubMedGoogle Scholar
  11. 11.
    Griepp RB, Ergin MA, Galla JD, Galla JD, Klein JJ, Spielvogel D, Griepp EB (1998) Mininizing spinal cord injury during repair of descending thoracic and thoracoabdominal aneurysms: the Mount Sinai Approach. Semin Thorac Cardiovasc Surg 10:25–28PubMedGoogle Scholar
  12. 12.
    Jacobs M, Meylaerts SA, de Haan P, de Mol BA, Kalkman CJ (1999) Strategies to prevent neurologic deficit based on motor-evoked potentials in type I and II thoracoabdominal aortic aneurysm repair. J Vasc Surg 29:48–57PubMedCrossRefGoogle Scholar
  13. 13.
    Kakinohana M, Fuchigami T, Nakamura S, Sasara T, Kawabata T, Sugahara K (2003) Intrathecal administration of morphine, but not small dose, induced spastic paraparesis after a noninjurious interval of aortic occlusion in rats. Anesth Analg 96:769–775PubMedGoogle Scholar
  14. 14.
    Kakinohana M, Kawabata T, Miyata Y, Sugahara K (2005) Myogenic transcranial motor evoked potentials monitoring cannot always predict neurological outcome after spinal cord ischemia in rats. J Thorac Cardiovasc Surg 129:46–52PubMedCrossRefGoogle Scholar
  15. 15.
    Lips J, de Haan P, de Jager SW, Vanicky I, Jacobs MJ, Kalkman CJ (2002) The role of transcranial motor evoked potentials in predicting neurologic and histopathologic outcome after experimental spinal cord ischemia. Anesthesiology 97:183–191PubMedCrossRefGoogle Scholar
  16. 16.
    Livesay JJ, Cooley DA, Ventemiglia RA, Ventemiglia RA, Montero CG, Warrian RK, Brown DM, Duncan JM (1985) Surgical experience in descending thoracic aneurysmectomy with and without adjuncts to avoid ischemia. Ann Thorac Surg 39:37–46PubMedCrossRefGoogle Scholar
  17. 17.
    Machida M, Weinstein SL, Yamada T, Kimura J, Toriyama S (1988) Dissociation of muscle action potentials and spinal somatosensory evoked potentials after ischemic damage of spinal cord. Spine 13:1119–1124PubMedCrossRefGoogle Scholar
  18. 18.
    Marsala J, Sulla I, Santa M, Marsala M, Mechirova E, Jalc P (1989) Early neurohistopathological changes of canine lumbosacral spinal cord segments in ischemia-reperfusion-induced paraplegia. Neurosci Lett 106:83–88PubMedCrossRefGoogle Scholar
  19. 19.
    Marsala M, Danielisova V, Chavko M, Hornakova A, Marsala J (1989) Improvement of energy state and basic modification of neuropathological damage in rabbits as a result of graded postischemic spinal cord reoxygenation. Exp Neurol 105:93–103PubMedCrossRefGoogle Scholar
  20. 20.
    Meylaerts SA, Jacobs MJ, van Iterson V, De Haan P, Kalkman CJ (1999) Comparison of transcranial motor evoked potentials and somatosensory evoked potentials during thoracoabdominal aortic aneurysm repair. Ann Surg 230:742–749PubMedCrossRefGoogle Scholar
  21. 21.
    Ryder J, Zappulla R, Nieves J (1991) Motor evoked potentials elicited from pyramidal stimulation and recorded from the spinal cord in the rat. Neurosurgery 28:550–558PubMedCrossRefGoogle Scholar
  22. 22.
    Schadrack J, Neto FL, Ableitner A,Castro-Lopes JM, Willoch F, Bartenstein P, Zieglgansberger W, Tolle TR (1999) Metabolic activity changes in the rat spinal cord during adjuvant monoarthritis. Neuroscience 94:595–605PubMedCrossRefGoogle Scholar
  23. 23.
    Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ (1993) Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 17:357–368PubMedCrossRefGoogle Scholar
  24. 24.
    Taira Y, Marsala M (1996) Effect of proximal arterial perfusion pressure on function, spinal cord blood flow, and histopathologic changes after increasing intervals of aortic occlusion in the rat. Stroke 27:1850–1858PubMedGoogle Scholar
  25. 25.
    Yamamoto N, Takano H, Kitagawa H, Kawaguchi Y, Tsuji H (1994) Changes of evoked action potentials and histopathology of the spinal cord, and hind limb dysfunction in spinal cord ischemia of cats. J Spinal Disord 7:285–295PubMedCrossRefGoogle Scholar
  26. 26.
    Yamamoto N, Takano H, Kitagawa H, Kawaguchi Y, Tsuji H, Uozaki Y (1994) Monitoring for spinal cord ischemia by use of the evoked spinal cord potentials during aortic aneurysm surgery. J Vasc Surg 20:826–833PubMedGoogle Scholar
  27. 27.
    Zivin JA, Waud DR (1992) Quantal bioassay and stroke. Stroke 23:767–773PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Manabu Kakinohana
    • 1
  • Seiya Nakamura
    • 1
  • Tatsuya Fuchigami
    • 1
  • Kazuhiro Sugahara
    • 1
  1. 1.Department of Anesthesiology University of the Ryukyus Nishihara, OkinawaJapan

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