[Intraoperative Monitoring of Cerebral and Spinal Cord Perfusion in Thoracic and Thoracoabdominal Aortic Surgery].

Abstract

Neurological complications during thoracic and thoracoabdominal aortic surgery remain significant issues affecting both postoperative quality of life and long-term survival. Inadequate cerebral and spinal cord perfusion, as well as embolic events, are major contributors to such outcomes. Near-infrared spectroscopy (NIRS)-based regional cerebral oxygen saturation (rSO2) monitoring allows continuous, non-invasive assessment of cerebral perfusion and has become a routine adjunct in high-risk procedures. Factors such as mean arterial pressure, arterial carbon dioxide tension (PaCO2), hemoglobin levels, and cardiac output all significantly influence rSO2 values. For spinal cord protection, motor evoked potential (MEP) monitoring provides a real-time assessment of the corticospinal tract integrity. Its utility is particularly prominent in thoracoabdominal aortic aneurysm repairs where spinal ischemia poses a risk of paraplegia. Prompt intraoperative responses-such as increasing blood pressure, cerebrospinal fluid drainage, or intercostal artery reconstruction-can be initiated based on MEP changes. At our institution, over 300 cases have been managed with MEP guidance, yielding favorable neurological outcomes. Integration of NIRS and MEP enables early detection of ischemia and timely interventions, thereby reducing neurological complications. Continued refinement and standardization of these modalities, in conjunction with other physiological and imaging assessments, are essential to further improve surgical outcomes.