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Überwachung von motorisch evozierten Potenzialen

Ein Diagnostik- und Strategie-Tool zur Vermeidung von neurologischen Komplikationen

Motor-evoked potentials monitoring

A diagnostic and strategic tool for avoidance of neurological complications

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Zusammenfassung

Die spinale Ischämie im Rahmen von thorakoabdominellen Aortenersatzeingriffen ist mit postoperativen Paresen und Paraplegien vergesellschaftet. Obwohl konventionelle Maßnahmen zum Schutz der perioperativen Rückenmarkperfusion getroffen werden, bleibt das Risiko für neurologische Komplikationen sowohl nach offenen als auch nach endovaskulären Aorteneingriffen relevant. Das neurophysiologische Monitoring von motorisch evozierten Potenzialen erlaubt auf nichtinvasive Art die Früherkennung von Störungen der Rückenmarkintegrität und kann somit intraoperative Strategien zum Schutz des Rückenmarks ermöglichen. Für die Rückenmarkversorgung relevante Interkostalarterien können mithilfe des Neuromonitorings identifiziert und in der aortalen Rekonstruktion in Form von Bypässen integriert werden. Auch in der endovaskulären Aortenchirurgie kann eine Gefährdung der Rückenmarkperfusion frühzeitig erkannt werden. Allerdings, aufgrund adaptierter endovaskulärer Versorgungsstrategien, erfährt das Neuromonitoring klinisch und wissenschaftlich nicht die gleiche Akzeptanz wie in der offenen Aortenchirurgie.

Abstract

Spinal ischemia during thoracoabdominal aortic interventions is associated with postoperative paresis and paraplegia. Although conventional measures for protection of perioperative spinal cord perfusion are initiated, there is still a relevant risk of neurological complications with both open and endovascular aortic interventions. Neurophysiological monitoring of motor-evoked potentials enables the early recognition of disorders of spinal cord integrity in a noninvasive manner and can therefore make intraoperative strategies for protection of the spinal cord possible. Intercostal arteries relevant for perfusion of the spinal cord can be identified by neuromonitoring and can be integrated into the aortic reconstruction in the form of bypasses. A threat to spinal cord perfusion can also be recognized at an early stage in endovascular aortic surgery; however, due to adapted endovascular treatment strategies, neuromonitoring has not been clinically and scientifically accepted, as is the case with open aortic surgery.

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    Panagiotis Doukas, Alexander Gombert & Michael Jacobs

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  1. Panagiotis Doukas
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  2. Alexander Gombert
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  3. Michael Jacobs
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Correspondence to Panagiotis Doukas.

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Interessenkonflikt

P. Doukas, A. Gombert und M. Jacobs geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Doukas, P., Gombert, A. & Jacobs, M. Überwachung von motorisch evozierten Potenzialen. Gefässchirurgie 27, 356–360 (2022). https://doi.org/10.1007/s00772-022-00909-x

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