15. Aortic IOM for thoraco-abdominal aneurysm surgery

Abstract

In this presentation, I will give an overview of why and how intraoperative neurophysiologic techniques help reducing post-operative neurologic deficit in Aortic surgery. I will start by briefly presenting the vascular anatomy of the spinal cord as well as of the main types of Aortic aneurysms, surgical repair procedures (i.e., open TAA repair with distal aortic perfusion and endovascular repair/TEVAR) and their associated neurological risks. I will continue with integrating the intraoperative neurophysiologic techniques within the main methods used for intraoperative neuroprotection that allow reaching the balance between metabolic demand of the spinal cord and its oxygen supply. Next, I will present the main neurophysiologic tests used during these procedures, including their role, and methodology. I will then give examples of how specific characteristics of neurophysiologic changes help with differential diagnosis of intraoperative spinal cord ischemia and its management. I will conclude with thoughts about delayed paraplegia and how intraoperative neurophysiology can help in predicting and preventing its occurrence, by informing the postoperative hemodynamic management in the ICU.