Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Aug 2007
ReviewNeurophysiology of surgical procedures for repair of the aortic arch.
Neurophysiologic monitoring during surgical procedures involving the aortic arch is very complex because of the number of different phases of the procedure, the high mortality rate, and the use of hypothermia. In this paper, the critical goals of neurophysiologic monitoring are discussed in the context of the different surgical events and the surgical options during the different phases of the procedure. ⋯ The role of EEG and evoked potentials in assessing the effect of hypothermia and circulatory arrest is also discussed. As these effects are predictable in large part, the neurophysiologist will be able to determine when changes in the neurophysiologic tests outside the norm occur and provide prompt warnings to the surgeon.
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J Clin Neurophysiol · Aug 2007
Neurophysiologic intraoperative monitoring during endovascular stent graft repair of the descending thoracic aorta.
Conventional surgery on the descending thoracic aorta for aneurysm or dissection repair typically involves open thoracotomy and cross-clamping of the aorta. These procedures are associated with the potential for significant neurologic morbidity due to spinal cord ischemia. ⋯ Several studies have demonstrated the utility of neurophysiologic intraoperative monitoring (NIOM) during conventional aortic surgery; however, less information is available regarding NIOM during EVSG repair. This paper reviews the data available regarding NIOM in EVSG repair of the descending thoracic aorta.
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J Clin Neurophysiol · Aug 2007
ReviewManagement of neurologic complications of thoracic aortic surgery.
Neurologic complications of thoracic aortic surgery are strongly associated with increased morbidity and mortality. Identifying preoperative risk factors for neurologic injury may enable us to refine our perioperative approach, and to lessen or avoid these complications. Methods to identify stroke and spinal ischemia intraoperatively such as neurophysiologic monitoring may enable us to improve outcomes in these patients by immediately instituting measures to improve brain and spine perfusion. The development of both protocols and therapies to treat these complications has allowed us to mitigate and, at times, reverse neurologic injury both intraoperatively and postoperatively.
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J Clin Neurophysiol · Aug 2007
ReviewElectrophysiologic monitoring during surgery to repair the thoraco-abdominal aorta.
Prevention of paraplegia during the repair of thoraco-abdominal aortic aneurysms and dissections present a substantial challenge to the operative team. The value of intraoperative electrophysiological monitoring (IOM) is to identify spinal cord ischemia that occurs during the procedure and guide the intraoperative management to reduce the risks of paralysis. The usefulness of IOM techniques requires an understanding of spinal cord blood flow and the spinal cord physiology, the surgical technique and their interaction. This paper will integrate these factors to review the laboratory and clinical experience with somatosensory evoked responses (SSEP) and motor evoked potentials (MEP) during thoraco-abdominal aorta surgery.