Use of Spinal Near-Infrared Spectroscopy for Monitoring Spinal Cord Perfusion During Endovascular Thoracic Aortic Repairs

PARAPERESIS REMAINS the most feared and unpredictable complication of open thoracoabdominal aneurysm (TAAA) repair, with an overall incidence of 16% in the Crawford benchmark series. 1 Crawford E.S. Crawford J.L. Safi H.J. et al. Thoracoabdominal aortic aneurysms: Preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg. 1986; 3: 389-404 Crossref PubMed Google Scholar Adjuncts such as cerebrospinal fluid (CSF) drainage and distal perfusion methods have decreased the incidence to 5% to 10%. 2 Cina C.S. Abouzahr L. Arena G.O. et al. Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery: A systematic review and meta-analysis. J Vasc Surg. 2004; 40: 36-44 Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar Despite these advances, paraparesis remains a devastating complication, with poor long-term outcome for patients. The use of near-infrared spectroscopy (NIRS) for measuring cerebral oxygen saturation during cardiac surgery has shown promising results 3 Murkin J.M. Adams S.J. Novick R.J. et al. Monitoring brain oxygenation during coronary bypass surgery: A randomized, prospective study. Anesth Analg. 2007; 104: 51-58 Crossref PubMed Scopus (615) Google Scholar and may be of use in adult head-injured and neonatal intensive care unit patients. 4 Smith M. Elwell C. Near-infrared spectroscopy: Shedding light on the injured brain. Anesth Analg. 2009; 108: 1055-1057 Crossref PubMed Scopus (40) Google Scholar , 5 Petrova A. Mehta R. Near-infrared spectroscopy in the detection of regional tissue oxygenation during hypoxic events in preterm infants undergoing critical care. Pediatr Crit Care Med. 2006; 7: 449-454 Crossref PubMed Scopus (98) Google Scholar With respect to spinal cord monitoring, LeMaire et al 6 LeMaire S.A. Ochoa L.N. Conklin L.D. et al. Transcutaneous near-infrared spectroscopy for detection of regional spinal ischemia during intercostal artery ligation: Preliminary experimental results. J Thorac Cardiovasc Surg. 2006; 132: 1150-1155 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar showed the use of NIRS in pigs and was able to detect induced regional spinal cord ischemia. The authors use of NIRS for intraoperative spinal cord monitoring in 2 patients presenting for TAAA repair including the accurate detection of spinal cord ischemia/infarction with both NIRS (INVOS cerebral oximeter; Somanetics Corporation, Troy, MI) and motor-evoked potential (MEP) monitoring (Epoch XP; Axon Corporation, Hauppauge, NY) in one is described.