The use of neuromonitoring in descending and thoraco-abdominal aortic aneurysm surgery: a review

Without surgical repair thoracic aortic aneurysms are a lethal disease with poor prognosis. An extensive major operation is required to correct an aneurysm that involves the descending or thoracoabdominal aorta. Particular considerations must be made to protection of all abdominal organs, the brain and the spinal cord which are all at risk. Consequently there is a risk that these patients post operatively wake up paraplegic from spinal cord ischaemia due to the nature of the surgery. Certain techniques have evolved that have considerably reduced this risk. Neuromonitoring is a technique that can provide an intraoperative assessment of the integrity of the spinal cord through stimulation of nervous pathways and detection in either peripheral muscles or the brain cortex. In theory this can alert the surgical team to impending spinal cord ischaemia and change the management of this patient to prevent paraplegia. However, there is much ambiguity surrounding its use, with no conclusive evidence to prove this technique effectively reduces the rates of paraplegia. This literature review will assess the current methods of neuromonitoring in thoracoabdominal aneurysm repair. Keywords-Thoracic aortic aneurysm, thoracoabdominal aneurysm, neuromonitoring, spinal cord ischaemia, biosensors