Uj módszer a cerebrospinalis fluidum (CSF) intraoperatív biokémiai monitorozásában thoracoabdominalis aortaaneurysma-mútétek során.

Translated title of the contribution: New method for the intraoperative biochemical monitoring of cerebrospinal fluid in surgery of thoracoabdominal aortic aneurysms

G. Nagy, C. Dzsinich, G. Sepa, L. Selmeci, M. Windisch, A. Petrohai, I. Gálfy, Z. Szabolcs

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Paraplegia remains to be one of the most dangerous complications following thoracoabdominal aortic surgery with an incidence of 0.5 to 40%. Therefore, intraoperative monitoring of spinal cord function is very important when choosing the appropriate surgical technique. Early detection of spinal cord injury continues to be a crucial problem, moreover, the currently applied electrophysiological methods appear to be inaccurate. The aim of the study was to detect prospective spinal cord injury intraoperatively by monitoring the biochemical parameters of the cerebrospinal fluid (CSF). The authors studied the reversible aerobic/anaerobic metabolic changes by monitoring CSF lactate levels, moreover S-100 protein and neuron-specific enolase (NSE) concentrations--specific for neuroglia and neuronal injury, respectively. One of the important methods to prevent paraplegia is the intraoperative CSF drainage, which may improve spinal cord perfusion. Between 1996-1998 51 patients underwent reconstructive thoracic or thoracoabdominal aortic aneurysm operation. The continuously drained CSF was collected in 10 ml fractions during the preparation, whereas during aortic cross-clamping and de-clamping 10 minute fractions were used. All CSF samples were immediately analysed intraoperatively for pH, pCO2, HCO3, potassium and lactate levels, S-100 protein and NSE were analysed by immunoluminescence. CSF lactate levels increased slightly during aortic clamping and a moderate, but non-significant increase was found in the hyperemic phase (reperfusion) in patients without spinal cord ischemia. Spinal cord injury was detected in 7 cases. These patients exhibited a significant CSF-lactate increase (control vs aortic cross-clamping: 1.9 vs 5.3 mmol/l), moreover CSF-lactate remained elevated throughout the whole operation. Paraplegia did not occur, Tarlov 2 paraparesis developed in four cases and three patients displayed cerebral damage. Intraoperative CSF--especially CSF-lactate--monitoring may help the operating team to detect early anaerobic changes of the metabolism the spinal cord.

Original languageHungarian
Pages (from-to)1343-1347
Number of pages5
JournalOrvosi Hetilap
Volume141
Issue number24
Publication statusPublished - Jun 11 2000

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Intraoperative Monitoring
Thoracic Aortic Aneurysm
Cerebrospinal Fluid
Lactic Acid
Constriction
Paraplegia
Spinal Cord Injuries
Spinal Cord
S100 Proteins
Phosphopyruvate Hydratase
Spinal Cord Ischemia
Anaerobiosis
Paraparesis
Neuroglia
Reperfusion
Potassium
Perfusion

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Uj módszer a cerebrospinalis fluidum (CSF) intraoperatív biokémiai monitorozásában thoracoabdominalis aortaaneurysma-mútétek során. / Nagy, G.; Dzsinich, C.; Sepa, G.; Selmeci, L.; Windisch, M.; Petrohai, A.; Gálfy, I.; Szabolcs, Z.

In: Orvosi Hetilap, Vol. 141, No. 24, 11.06.2000, p. 1343-1347.

Research output: Contribution to journalArticle

Nagy, G, Dzsinich, C, Sepa, G, Selmeci, L, Windisch, M, Petrohai, A, Gálfy, I & Szabolcs, Z 2000, 'Uj módszer a cerebrospinalis fluidum (CSF) intraoperatív biokémiai monitorozásában thoracoabdominalis aortaaneurysma-mútétek során.', Orvosi Hetilap, vol. 141, no. 24, pp. 1343-1347.
Nagy, G. ; Dzsinich, C. ; Sepa, G. ; Selmeci, L. ; Windisch, M. ; Petrohai, A. ; Gálfy, I. ; Szabolcs, Z. / Uj módszer a cerebrospinalis fluidum (CSF) intraoperatív biokémiai monitorozásában thoracoabdominalis aortaaneurysma-mútétek során. In: Orvosi Hetilap. 2000 ; Vol. 141, No. 24. pp. 1343-1347.
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AU - Sepa, G.

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AU - Gálfy, I.

AU - Szabolcs, Z.

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