Protection from postischemic spinal cord injury by perfusion cooling of the epidural space during most or all of a descending thoracic or thoracoabdominal aneurysm repair

  • Koichi Tabayashi
  • Yoshikatsu Saiki
  • Hiroaki Kokubo
  • Goro Takahashi
  • Junetsu Akasaka
  • Seijirou Yoshida
  • Masaki Hata
  • Koki Niibori
  • Makoto Miura
  • Toshiaki Konnai
Original Article



It is reported that hypothermia has some protective effect against ischemia of the spinal cord during thoracoabdominal aneurysm repair. However, it has not been elucidated clinically whether regional spinal cord hypothermia by epidural perfusion cooling is effective and safe. The purpose of this study was to assess the effect and safety of perfusion cooling of the epidural space during most or all of descending thoracic or thoracoabdominal aneurysm repair.


From January 1998 to December 2007, a total of 102 patients with a mean age of 61 years underwent replacement of most or all of the descending thoracic aorta or thoracoabdominal aorta with the aid of mild hypothermia via epidural perfusion cooling and cerebrospinal fluid (CSF) drainage. Risk factors for spinal cord injury and hospital death were analyzed using univariate and multivariate analyses. The actuarial survival rate was calculated by the Kaplan-Meier method.


The mean lowest CSF temperature was 23.3°C during epidural perfusion cooling. The mean temperature difference between the nasopharynx and CSF was 8.4°C. The incidence of spinal cord injury was 3.9% (4/102), and that of hospital death was 5.9% (6/102). There was no significant risk factor associated with spinal cord injury. Type III aneurysm and postoperative cerebrovascular accident, respiratory failure, liver failure, and infection were predictors of hospital death. The actuarial survival rates at 3 and 5 years were 82.1% and 75.9%, respectively.


Epidural perfusion cooling is a safe method to employ in clinical situations. Our contemporary management strategies enabled patients to undergo thoracoabdominal aneurysm repair with excellent early and late survival and acceptable morbidity.

Key words

Aneurysm Hypothermia Spinal cord 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tabayashi K, Niibori K, Konnno H, Mohri H. Protection from postischemic spinal cord injury by perfusion cooling of the epidural space. Ann Thorac Surg 1993;56:498–498.CrossRefGoogle Scholar
  2. 2.
    Davison JK, Cambria RR, Vierra DJ, Columbia MA, Koustas G. Epidural cooling for regional spinal cord hypothermia during thoracoabdominal aneurysm repair. J Vasc Surg 1994;20:304–310.PubMedGoogle Scholar
  3. 3.
    Coselli JS, Bozinouski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysm. Ann Thorac Surg 2007;83:S862–S864.CrossRefPubMedGoogle Scholar
  4. 4.
    Kouchoukos NT, Masetti R, Rokkas CK, Murphy SF, Blackstone EH. Safety and efficacy of hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending thoracic and thoraco-abdominal aorta. Ann Thorac Surg 2001;72:699–708.CrossRefPubMedGoogle Scholar
  5. 5.
    Keyhani K, Miller CC 3rd, Estrera AL, Wegryn T, Sheinbaum R, Safi HJ. Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair. J Vasc Surg 2009;49:36–41.CrossRefPubMedGoogle Scholar
  6. 6.
    Charagozloo F, Larson J, Dausmass MJ, Nevilie RF, Gomes MM. Spinal cord protection during surgical procedures on the descending thoracic and thoracoabdominal aorta: Review of current techniques. Chest. 1996;109:799–809.CrossRefGoogle Scholar
  7. 7.
    Safi HJ, Miller CC, Subramanian MH, Campbell MP, Iliopoulos DC, O’Donnell JJ, et al. Thoracic and thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass, profound hypothermia, and circulatory arrest via left side of the chest incision. J Vasc Surg 1998;28:591–598.CrossRefPubMedGoogle Scholar
  8. 8.
    Motoyoshi N, Sakurai M, Hayashi T, Aoki M, Abe K, Itoyama Y, et al. Establishment of a local cooling model against spinal cord ischemia representing prolonged induction of heat shock protein. J Thorac Cardiovasc Surg 2001;122: 351–357.CrossRefPubMedGoogle Scholar
  9. 9.
    Vacanti FX, Ames A. Mild hypothermia and Mg protect against irreversible damage during CND ischemia. Stroke 1984;15:695–698.PubMedGoogle Scholar
  10. 10.
    Marsala M, Vanicky I, Galik J, Radonak J, Kundrat I, Marsala J. Panmyelic epidural cooling protects against ischemic spinal cord damage. J Surg Res 1993;55:21–31CrossRefPubMedGoogle Scholar
  11. 11.
    Tabayashi K, Motoyoshi N, Akimoto H, Tsuru Y, Sakurai M, Itoh T, et al. Epidural cooling for regional spinal cord hypothermia during most or all of descending thoracic or thoracoabdominal aneurysm repair. Acta Chir Belg 2002;102: 224–229.PubMedGoogle Scholar
  12. 12.
    Tabayashi K, Motoyoshi N. Spinal cord protection by epidural cooling. Ann Thorac Surg 2001;71:1063–1064.CrossRefPubMedGoogle Scholar
  13. 13.
    Tabayashi K, Motoyoshi N, Saiki Y, Kokubo H, Takahashi G, Masuda S, et al. Efficacy of perfusion cooling of the epidural space and cerebrospinal fluid drainage during repair of extent I and II thoracoabdominal aneurysm. J Cardiovasc Surg (Torino) 2008;49:749–755.Google Scholar
  14. 14.
    Acher CW, Wynn MM, Hoch JR, Popic P, Archibald J, Turnipseed MD. Combined use of cerebral spinal fluid drainage and naloxone reduces the risk of paraplegia in thoracoabdominal aortic aneurysm repair. J Vasc Surg 1994;19: 236–248.PubMedGoogle Scholar
  15. 15.
    Jacobs MJHM, Meylaerts SA, deHaan P, deMol BA, Kalkman CJ. Strategies to prevent neurologic potentials in type I and II thoracoabdominal aortic aneurysm repair. J Vasc Surg 1999;29:48–59.CrossRefPubMedGoogle Scholar
  16. 16.
    Coselli JS, LeMaire SA, Koksoy C, Schmitting ZC, Curling PE. Cerebrospinal fluid drainage reduces paraplegia following thoracoabdominal aortic aneurysm repair: results of a prospective randomized trial. J Vase Surg 2002;35:631–639.CrossRefGoogle Scholar
  17. 17.
    Conrad MF, Crawford RS, Davison JK, Cambria RP. Thoracoabdominal aneurysm repair: a 20-year perspective. Ann Thorac Surg 2007;83:S856–S861.CrossRefPubMedGoogle Scholar
  18. 18.
    Kazui T, Yamashita K, Terada H, Washiyama N. Retrograde segmental thoracoabdominal aortic aneurysm. J Thorac Cardiovasc Surg 2004;127:1827–1829.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2010

Authors and Affiliations

  • Koichi Tabayashi
    • 1
  • Yoshikatsu Saiki
    • 1
  • Hiroaki Kokubo
    • 2
  • Goro Takahashi
    • 1
  • Junetsu Akasaka
    • 1
  • Seijirou Yoshida
    • 3
  • Masaki Hata
    • 4
  • Koki Niibori
    • 2
  • Makoto Miura
    • 5
  • Toshiaki Konnai
    • 6
  1. 1.Department of Cardiovascular Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan
  2. 2.Medical CenterIbarakimachiJapan
  3. 3.Sendai Open HospitalSendaiJapan
  4. 4.Aomori Prefectural Central HospitalAomoriJapan
  5. 5.Tohoku Kosei Nenkin HospitalSendaiJapan
  6. 6.Miyagi Cardiovascular & Respiratory CenterMiyagiJapan

Personalised recommendations