OBJECTIVES: Spinal cord injury is detrimental for patients undergoing open or endovascular
thoracoabdominal aortic aneurysm (TAAA) repair. The aim of this survey and of the
modified Delphi consensus was to gather information on current practices and standards
in neuroprotection in patients undergoing open and endovascular TAAA. METHODS: The
Aortic Association conducted an international online survey on neuromonitoring in
open and endovascular TAAA repair. In a first round an expert panel put together a
survey on different aspects of neuromonitoring. Based on the answers from the first
round of the survey, 18 Delphi consensus questions were formulated. RESULTS: A total
of 56 physicians completed the survey. Of these, 45 perform open and endovascular
TAAA repair, 3 do open TAAA repair and 8 do endovascular TAAA repair. At least 1 neuromonitoring
or protection modality is utilized during open TAAA surgery. Cerebrospinal fluid (CSF)
drainage was used in 97.9%, near infrared spectroscopy in 70.8% and motor evoked potentials
or somatosensory evoked potentials in 60.4%. Three of 53 centres do not utilize any
form of neuromonitoring or protection during endovascular TAAA repair: 92.5% use CSF
drainage; 35.8%, cerebral or paravertebral near infrared spectroscopy; and 24.5% motor
evoked potentials or somatosensory evoked potentials. The utilization of CSF drainage
and neuromonitoring varies depending on the extent of the TAAA repair. CONCLUSIONS:
The results of this survey and of the Delphi consensus show that there is broad consensus
on the importance of protecting the spinal cord to avoid spinal cord injury in patients
undergoing open TAAA repair. Those measures are less frequently utilized in patients
undergoing endovascular TAAA repair but should be considered, especially in patients
who require extensive coverage of the thoracoabdominal aorta.
