Cyber medicine enables remote neuromonitoring during aortic surgery

TY - JOUR

T1 - Cyber medicine enables remote neuromonitoring during aortic surgery

AU - Greiner, Andreas

AU - Mess, Werner H

AU - Schmidli, Juerg

AU - Debus, Eike S

AU - Grommes, Jochen

AU - Dick, Florian

AU - Jacobs, Michael J

N1 - Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

PY - 2012/5

Y1 - 2012/5

N2 - OBJECTIVE: This study assessed the feasibility and effectiveness of remote neuromonitoring as an adjunct to spinal cord protection during surgical repair of descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms.METHODS: Four aortic centers in three European countries participated in this prospective observational study. A similar surgical protocol was used in all centers, including assessment of spinal cord function by means of monitoring motor-evoked potentials (MEPs). MEP information was evaluated at one central neurophysiologic department in Maastricht, The Netherlands. Transfer of MEP data from all operating rooms to Maastricht was arranged by Internet connections. In all patients, the protective and surgical strategies to prevent paraplegia were based on MEPs. The on-site surgeons reacted in real time to the interpretation and feedback of the neurophysiologist.RESULTS: Between March 2009 and May 2011, 130 patients (85 men) were treated by open surgical repair. Extent of aneurysms was equally distributed among the centers. Neuromonitoring was technically stabile and successful in all patients. The transfer of data from the operating room in the different vascular centers was undisturbed and without any technical problems. By maintaining a mean distal aortic pressure of 60 mm Hg, MEPs were undisturbed in 65 patients (50%). In another 65 patients (50%), significant changes in MEPs prompted the surgical teams to initiate additional protective and surgical strategies to restore spinal cord perfusion. These measures were not effective in five patients (3.8%), and acute paraplegia resulted. Delayed paraplegia occurred in 10 patients (7.7%) but improved in three and recovered completely in another three. No false-negative or false-positive MEP recordings were experienced.CONCLUSIONS: Remote neuromonitoring of spinal cord function during open repair of descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms as a telemedicine technique is feasible and effective. It allows centralization of expertise and saves individual centers from investing in complex technology. The value of monitoring MEPs was confirmed in different aortic centers, resulting in adequate neurologic outcome after extensive aortic surgical procedures.

AB - OBJECTIVE: This study assessed the feasibility and effectiveness of remote neuromonitoring as an adjunct to spinal cord protection during surgical repair of descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms.METHODS: Four aortic centers in three European countries participated in this prospective observational study. A similar surgical protocol was used in all centers, including assessment of spinal cord function by means of monitoring motor-evoked potentials (MEPs). MEP information was evaluated at one central neurophysiologic department in Maastricht, The Netherlands. Transfer of MEP data from all operating rooms to Maastricht was arranged by Internet connections. In all patients, the protective and surgical strategies to prevent paraplegia were based on MEPs. The on-site surgeons reacted in real time to the interpretation and feedback of the neurophysiologist.RESULTS: Between March 2009 and May 2011, 130 patients (85 men) were treated by open surgical repair. Extent of aneurysms was equally distributed among the centers. Neuromonitoring was technically stabile and successful in all patients. The transfer of data from the operating room in the different vascular centers was undisturbed and without any technical problems. By maintaining a mean distal aortic pressure of 60 mm Hg, MEPs were undisturbed in 65 patients (50%). In another 65 patients (50%), significant changes in MEPs prompted the surgical teams to initiate additional protective and surgical strategies to restore spinal cord perfusion. These measures were not effective in five patients (3.8%), and acute paraplegia resulted. Delayed paraplegia occurred in 10 patients (7.7%) but improved in three and recovered completely in another three. No false-negative or false-positive MEP recordings were experienced.CONCLUSIONS: Remote neuromonitoring of spinal cord function during open repair of descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms as a telemedicine technique is feasible and effective. It allows centralization of expertise and saves individual centers from investing in complex technology. The value of monitoring MEPs was confirmed in different aortic centers, resulting in adequate neurologic outcome after extensive aortic surgical procedures.

KW - Aged

KW - Aortic Aneurysm, Thoracic/physiopathology

KW - Blood Pressure

KW - Centralized Hospital Services

KW - Europe

KW - Evoked Potentials, Motor

KW - Feasibility Studies

KW - Feedback, Psychological

KW - Female

KW - Humans

KW - Internet

KW - Male

KW - Middle Aged

KW - Monitoring, Intraoperative/methods

KW - Paraplegia/diagnosis

KW - Perfusion

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Regional Blood Flow

KW - Remote Consultation

KW - Spinal Cord/blood supply

KW - Spinal Cord Ischemia/diagnosis

KW - Time Factors

KW - Treatment Outcome

KW - Vascular Surgical Procedures/adverse effects

U2 - 10.1016/j.jvs.2011.11.121

DO - 10.1016/j.jvs.2011.11.121

M3 - SCORING: Journal article

C2 - 22341581

VL - 55

SP - 1227

EP - 1232

JO - J VASC SURG

JF - J VASC SURG

SN - 0741-5214

IS - 5

ER -