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Results for “Monitoring, Intraoperative”

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PubMed2002

[Neural axis abnormalities detected by preoperative magnetic resonance imaging in patients with type III idiopathic scoliosis].

OBJECTIVES: We investigated the presence of neural axis abnormalities by magnetic resonance imaging (MRI) in patients with clinically and radiologically confirmed absolute flexible thoracic curves (King-Moe type III). METHODS: Preoperative MRI scans of 84 patients (34 males, 50 females; mean age 14.1 years; range 11 to 17 years) with adolescent idiopathic scoliosis and a flexible thoracic curve (King-Moe type III) were prospectively evaluated to determine neural axis abnormalities. Clinical and radiologic indications for preoperative MRI examination were sought. All patients were treated with posterior fusion. All patients were intraoperatively monitored by means of motor evoked potentials by magnetic transcortical stimulation and somatosensory evoked potentials. The mean follow-up was 50.1 months (range 24 to 105 months). RESULTS: Neural axis abnormalities were detected in six patients (7.1%), including syringomyelia in five patients (5.9%) and diastometamyelia in one patient (1.2%). Of 84 patients, 51 patients (60.7%) had a relatively decreased spinal cord diameter, and an increased epidural distance. No clinical or radiologic indicators were found for preoperative MRI examination. No neurologic deficits developed during operation and in the postoperative period. CONCLUSION: The detection of neural axis abnormalities implies the necessity of intraoperative neurologic monitoring to minimize the risks for neurologic deficits. Where this is not available, preoperative MRI seems to be an essential tool in the prevention of surgery-associated neurologic risks.

Adolescent↗

PubMed1991

[Peroperative massive pulmonary embolism of tumoral origin. Value of extensive monitoring].

A case is reported of a 47-year-old female patient who suffered from massive tumour embolism during a nephrectomy for a renal carcinoma invading the inferior vena cava. Intraoperative monitoring consisted in direct blood pressure measurement (radial artery cannula), central haemodynamic monitoring (Swan-Ganz catheter), pulse oximetry and capnography. During the surgical manipulation of the suprahepatic vena cava, Petco2 suddenly decreased (from 25 mmHg to 14 mmHg), together with Spo2 (from 99% to 89%), and the mean pulmonary arterial pressure increased from 18 mmHg to 40 mmHg. The drop in arterial blood pressure to 50/30 mmHg, initiated an immediate sternotomy. After clamping the superior and inferior venae cavae, numerous tumour fragments were removed from the pulmonary artery. Cardiac activity restarted after internal cardiac massage, 1 mg adrenaline, 1 g calcium chloride and 150 mmol of molar sodium bicarbonate. The whole procedure lasted 30 min. Arterial blood pressure became stable at 110/50 mmHg, pulmonary arterial and wedge pressures at 20 and 5 mmHg. The Spo2 increased to 98%, and Petco2 to 25 mmHg. The nephrectomy was then carried out, the patient being given 5 micrograms.kg-1.min-1 dobutamine and 3 micrograms.kg-1.min-1 dopamine. At the end of surgery, systolic blood pressure was 120 mmHg, mean pulmonary arterial pressure 25 mmHg, and PaCO2 34 mmHg. The patient left the intensive care unit after twelve days. After one year of follow-up, no complication had occurred. The value of cardiopulmonary bypass in nephrectomy for renal carcinoma invading the vena cava, or the renal vein, is discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed2006

Recurrent laryngeal nerve monitoring during thyroid surgery in childhood.

INTRODUCTION: Diseases of the thyroid gland are one of the most common endocrinopathies in childhood. Neither benign nor malignant thyroid diseases are often treated surgically. But if surgical treatment is carried out, intraoperative damage of the recurrent laryngeal nerve (RLN) is a common and severe complication. In adult surgery, therefore, intraoperative monitoring (IOM) of the RLN is a method which has been used since several years. The question is whether this method can be used in paediatric surgery for the identification and functional control of the integrity of the RLN. METHODS: Surgical treatment of benign (9 x) or malignant (1 x) thyroid diseases was performed in ten children (median age: 13 years) with 16 nerves at risk (NAR). The function of the vocal cord was controlled in all children before and after surgery. Intraoperative identification and functional control of the recurrent nerve was performed using the Neurosign 100, placing a needle electrode transligamentously into the vocal muscle. All results before and after resection were documented. RESULTS: A clear and reliable identification of the RLN was possible in all cases. All NAR showed a constant physiological nerve signal before and after surgical resection of the thyroid gland. However in one young patient the postoperative control of the vocal cord revealed a partial paralysis despite the constant intraoperative signal of the RLN. The control on this patient after a period of six months showed a normal function. CONCLUSION: IOM of the RLN as used in adult surgery could easily be used in paediatric surgery as well. A clear and positive identification of the RLN was possible in all these patients. Therefore, IOM of the RLN could develop into a helpful and easy method for the prevention of intraoperative damage of the recurrent laryngeal nerve during thyroid surgery in childhood.

Adolescent↗

PubMed1999

The prognostic value of intraoperative BAEP patterns in acoustic neurinoma surgery.

Based on a consecutive series of 70 hearing patients with unilateral acoustic neurinomas and intraoperative monitoring of brain-stem auditory evoked potentials (BAEP), 4 dynamic BAEP patterns could be characterized. These patterns correspond with early and late postoperative hearing outcome. All patients with stable wave V (pattern 1) showed definite hearing preservation, all patients with irreversible abrupt loss of BAEP (pattern 2) lost their hearing, despite early hearing preservation in two cases. All patients with irreversible progressive loss of either wave I or wave V (pattern 3) eventually suffered from definite postoperative hearing loss, despite early hearing preservation in two cases. Those cases with intraoperative reversible loss of BAEP (pattern 4) showed variable short and long term hearing outcome. In 34% hearing was preserved, 44% suffered from postoperative hearing loss, the remaining 22% showed postoperative hearing fluctuation, either as a delayed hearing loss or as reversible hearing loss. Postoperative hearing fluctuation indicates anatomical and functional preservation of the cochlear nerve during surgery and is suggestive of a pathophysiological mechanism initiated during the surgical procedure and continuing thereafter. Patients at risk for delayed hearing loss can be identified during surgery by a characteristic BAEP pattern and may benefit from vasoactive treatment.

Audiometry, Pure-Tone↗

PubMed2001

Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: a 2-institution experience.

BACKGROUND: We hypothesized that intraoperative parathyroid hormone monitoring (IOPTH) reliably would detect double parathyroid adenomas. METHODS: This was a retrospective study of 20 patients undergoing conventional parathyroidectomy with resection of exactly 2 abnormal glands. Full exploration was performed regardless of IOPTH values, which were measured after anesthetic induction and 5 and 10 minutes following removal of the first abnormal parathyroid gland. Failure to fall below 50% of baseline value by 10 minutes following resection of the first gland indicated the presence of multiglandular disease. RESULTS: All patients were cured. All excised glands were hypercellular on histology. Mean IOPTH values in 9 of the 20 patients with true negative results (noncurative decrease, another gland present) were 66% +/- 7% at 5 minutes and 83% +/- 15% at 10 minutes. The IOPTH values in 11 of the 20 patients with false positive results (curative decrease, another gland present) were 28% +/- 4% at 5 minutes and 18% +/- 2% at 10 minutes. The false positive rate of IOPTH was 55%. CONCLUSIONS: We found that IOPTH failed to reliably detect the presence of double parathyroid adenomas. These data suggest that caution should be exercised when terminating limited parathyroid exploration based on a curative fall in IOPTH values.

Adenoma↗

PubMed2005

Four-channel electromyography of the facial nerve in vestibular schwannoma surgery: sensitivity and prognostic value for short-term facial function outcome.

OBJECTIVE: To evaluate the short-term facial prognostic value of a four-channel facial electromyographic device in vestibular schwannoma surgery. STUDY DESIGN: Eighty-nine vestibular schwannomas operated on and intraoperatively monitored by a four-channel facial electromyographic device between October 2002 and September 2003 were included in this prospective study. Detection was performed in frontal, orbicularis oculi, orbicularis oris, and platysma muscles. MAIN OUTCOME MEASURE: Facial function grading at postoperative Days 1, 8, 30, and 180 (House-Brackmann classification). SETTING: Tertiary referral center. RESULTS: Postoperative facial function at Day 180 was assessed as Grade 1 or 2 in 80%, as Grade 3 or 4 in 16%, and as Grade 5 or 6 in 4% (n=80). The postoperative facial function was related to the intraoperative nerve stimuli thresholds (range, 0.01-3 mA for a response >100 microV) near the brainstem and the proximal-to-distal ratio of the stimulation threshold. A proximal threshold between 0.01 and 0.04 mA had a positive predictive value of 94% for good facial function (Grade 1 or 2). The proximal threshold was lower in patients with improving or stable facial function in comparison with those with a delayed deterioration between Days 8 and 30. The stimulation threshold at the adhesion zone was related to the immediate facial function outcome. The maximal electromyographic response was detected in the frontal muscle or the platysma in 27% of cases and in orbicularis oris and oculi in 73% of cases. CONCLUSION: A four-channel device may enhance electromyographic sensitivity. Determination of stimulation threshold below 0.05 mA yields facial prognostic information.

Adolescent↗

PubMed1995

Postoperative neuropsychological dysfunction and cerebral oxygenation during cardiac surgery.

In 41 patients undergoing cardiac operations with extracorporeal circulation, oxidized cytochrome a,a3(CtO2), deoxygenated hemoglobin (Hb), and oxygenated hemoglobin (HbO2) were measured in brain tissue by near-infrared spectrophotometry (NIRS) intraoperatively. Monitoring also included electroencephalography (EEG) and jugular-bulb venous saturation (SBJO2). All operations were performed using membrane oxygenators, moderate hypothermia (26-28 degrees C) and pH alpha-stat management. During cardiopulmonary bypass (CPB) CtO2 and HbO2) were reduced, reaching minimal values when rewarming was instituted. At the end of the operation CtO2 and HbO2 had regained initial levels. During CPB, arterial PCO2, pH, and temperature were closely related to CtO2 (r = 1000, r = -0.964 and 0.929 respectively; p < 0.001, p < 0.001, and p < 0.003 respectively). Neuropsychological testing by the Mini-Mental-State Test indicated reversible postoperative neuropsychological deficits in four patients. There patients had a lower CtO2 minimum compared to those without these deficits (-4.5 mumol/L v. -0.7 mumol/L; p = 0.036). These findings support the hypothesis that neuropsychological deficits in patients after cardiac surgery can be caused by intraoperative cerebral hypoxia.

Adult↗

PubMed2000

Nerve rootlets to be sectioned for spasticity resolution in selective dorsal rhizotomy.

BACKGROUND: The goal of this study is to confirm the efficacy of the protocol for selective dorsal rhizotomy (SDR). In this protocol, rootlets to be sectioned are selected by palpable responses elicited by intraoperative electrical stimulation, without detailed electromyographic classifications. METHODS: Thirty-six children with spasticity due to cerebral palsy underwent SDR according to our protocol. Priority was given to sectioning rootlets that showed palpable clonic or bilateral responses, which were considered abnormal, over sectioning rootlets that merely had hyperactive responses to intraoperative stimulation. The results of intraoperative monitoring and sectioning amount were analyzed by physical evaluation. RESULTS: Significant improvements were obtained in passive range of motion and muscle tone of the lower extremities. The total percentages of rootlets with abnormal and hyperactive responses at L3 and S1 were bilaterally correlated with preoperative spasticity of the hip adductors and the plantar flexors, respectively. When rootlets with hyperactive responses were excluded from the correlation analysis, no bilateral correlation was observed. From the correlation analyses between the improvement in the physical evaluation and the amount of nerve sectioned, it was concluded that a greater improvement in muscle tone in all examined muscles, except the hamstrings, could be obtained if larger amounts of nerve roots were sectioned. CONCLUSION: The number of rootlets with palpable abnormal and hyperactive responses elicited by intraoperative stimulation reflects the preoperative spasticity of multiple muscles. This implies that only selecting rootlets with palpable responses can be reliable. Because more sectioning leads to better spasticity resolution, our protocol should be reviewed to increase the percentage of rootlets sectioned with hyperactive responses, especially for innervated levels of severely affected muscles.

Adolescent↗

PubMed2002

Temperature rise during reamed tibial nailing.

The current study determined the temperature rise during reamed tibial intramedullary nailing in vivo. Eighteen adult patients were studied. The tibial medullary canal diameter ranged from 8 to 11 mm and was reamed to at least 1.5 mm above the required nail diameter with AO reamers. Reaming of the medullary cavity ranged from 9 to 12 mm before nail insertion. Intraoperative monitoring of the heat produced during reaming of the medullary cavity was done by inserting two platinum resistance thermometer probes into the cortical bone at the short isthmic segment of the tibial shaft. The probes were connected to a data logger, and temperature readings were taken every 5 seconds during each reaming procedure. The mean tibial temperature before initiation of reaming was 35.6 degrees C (standard deviation, +/- 0.5 degrees), and peak temperatures recorded were from 36.1 degrees C to 51.6 degrees C. A direct correlation was observed between temperature elevation and amount of reaming. With reaming above 10 mm, tibias with a canal diameter of 8 mm showed a statistically higher temperature rise compared with tibias with a canal diameter of 9, 10, or 11 mm. No patients had intraoperative or postoperative complications related to skin or bone thermal necrosis, and bony healing progressed uneventfully. The small amount of reaming required to insert a nail into a normal 9-, 10-, or 11- mm tibial canal does not seem to produce a clinical problem. Reaming smaller canals (8 mm) to a larger size may induce a significant heating effect.

Adolescent↗

PubMed1992

Predictive criteria for the need of extracorporeal circulation in single-lung transplantation.

Use of extracorporeal circulation is mandatory in heart-lung and en bloc double-lung transplantation. However, no criteria exist to predict the necessity of its application during single-lung transplantation for parenchymal lung diseases. We therefore reviewed our experience in 23 patients undergoing single-lung transplantation for idiopathic pulmonary fibrosis. All patients were evaluated by preoperative right heart catheterization. For intraoperative monitoring, a pulmonary artery thermodilution catheter was placed in the contralateral lung to repeatedly assess pulmonary artery pressure, cardiac output, and pulmonary vascular resistance. Extracorporeal circulation was necessary during graft implantation in 4 patients, whereas 19 patients underwent operation without it. Preoperative demographic patient data, time of ischemia, and hemodynamic values obtained preoperatively and before the clamping of the pulmonary artery showed no significant differences between groups. In contrast, after the clamping of the pulmonary artery, a significant drop in cardiac index of about 1.5 L.min-1.m-2 (p less than 0.01) and a concomitant rise in pulmonary vascular resistance (p less than 0.01) was observed in the group requiring extracorporeal circulation, whereas these variables showed no significant changes in the other 19 patients. Pulmonary artery pressure rose significantly in both groups (p less than 0.05), without significant differences between them. It is concluded that intraoperative assessment of cardiac index and pulmonary vascular resistance is essential for estimation of cardiac performance during single-lung transplantation. A decrease in cardiac index of more than 1.5 L.min-1.m-2 after the clamping of the pulmonary artery rather than the degree of pulmonary hypertension is indicative of the need of extracorporeal circulation.

Adult↗

PubMed2004

Effects of opening peritumoral syrinxes on motor evoked potentials during resection of an intramedullary spinal cord tumor--case report.

A 29-year-old woman presented with mild tetraparesis caused by an intramedullary cervical cord tumor extending from the C-5 to C-6 levels associated with rostral and caudal syrinxes extending to the C-1 and C-7 levels. Transcranial motor evoked potential (MEP) monitoring was carried out during tumor resection using high-frequency repetitive electrical stimulation. When the rostral syrinx was opened, the MEP amplitude in the right upper limb suddenly decreased by about 50%. When the caudal syrinx was opened, the amplitude immediately recovered to the baseline. During dissection of the attachment of the tumor, the amplitude decreased again by 70%, and did not recover. The tumor was totally removed. The histological diagnosis was ependymoma. Postoperatively, motor weakness in the right arm deteriorated but gradually recovered. The initial loss of amplitude on opening of the rostral syrinx may have resulted from distortion of the intramedullary pressure that compromised function of the motor tract nearby. Opening of the caudal syrinx normalized the intramedullary pressure and allowed the MEP to recover. Intraoperative monitoring of MEPs is valuable in minimizing injury to corticospinal pathways, but care must be taken in evaluating changes in MEP. Intramedullary spinal tumors with associated syrinxes are not rare, so surgeons should realize that opening of a syrinx can lead to MEP changes.

Adult↗

PubMed1983

Method for continuous conjunctival oxygen monitoring during carotid artery surgery.

A new device for measuring conjunctival oxygen tension (PcjO2) was used for intraoperative monitoring during carotid endarterectomy. The PcjO2 measures local tissue oxygenation and, thus, reflects the oxygen delivery to the areas supplied by the internal carotid artery. PcjO2 was found to be sensitive to manipulation, clamping, and obstruction of the carotid artery; it provided a useful monitoring system for assessment of the cerebral circulation during carotid surgery.

Aged↗

PubMed1991

Operative monitoring of parathyroid gland hyperfunction.

With a 20-year experience of more than 700 parathyroidectomies, our persistent hypercalcemic postoperative failure rate of 7% has remained constant. Reasons for failure have been misdiagnosis or inability of the surgeon to detect and excise all hypersecreting glands. We have modified a commercially available immunoradiometric assay for intact parathyroid hormone (PTH) resulting in a 15-minute turnaround time. Since intact PTH has a half-life measured in minutes, whole blood samples taken 10 minutes after gland excisions were monitored intraoperatively to confirm significant changes in circulating hormone. Quantitative evidence that all hyperfunctioning parathyroid tissue had been ablated during operation was obtained in 19 of 21 patients. Less than four glands each were identified in 53% of these patients. The PTH "quick" test correctly pointed to an inadequate excision requiring further parathyroid ablation in two patients, made bilateral neck exploration unnecessary in two patients who had previously undergone parathyroidectomy, and predicted persistent hypercalcemia in two patients with complications.

Humans↗

PubMed1997

The reliability of evoked spinal cord potentials elicited by direct stimulation of the cord as a monitor of spinal cord ischemia during temporary occlusion of the thoracic aorta.

Paraplegia is a severe and disastrous complication of operations on the thoracic aorta. For preventing this complication, we employed evoked spinal cord potentials elicited by direct stimulation of the cord (ESPs-dsc) during operations on 83 patients with various aortic lesions (37 dissecting and 46 cases of nondissecting aneurysms, 35 descending and 48 thoracoabdominal aortic aneurysms). All of the patients had some form of circulatory adjunct during aortic cross-clamping. Of the 83 patients, three had "immediate" paraparesis and five had "immediate" paraplegia, whereas three other patients had "delayed" paraplegia. During operation, four types of ESPs-dsc response pattern were observed: (1) no change (n = 57), (2) change with return (n = 15), (3) change with inconsistent return (n = 6), (4) change without return (n = 5). "Delayed" paraplegia occurred in two patients with "no change" and "change with return" response (3%), "immediate" paralysis occurred in three and "delayed" paraplegia occurred in one of those with "change with inconsistent return" response (67%), and all of those with "change with inconsistent return" response (67%), and all of those with "change without return" response developed "immediate" paraplegia (100%). We conclude that intraoperative monitoring of spinal cord function utilizing ESPs-dsc is a good indicator of spinal cord ischemia and we can improve the outcome according to its changes.

Aorta, Thoracic↗

PubMed1996

Intraoperative phrenic nerve monitoring in cardiac surgery.

BACKGROUND: Left hemidiaphragmatic paralysis due to phrenic nerve lesion is a frequent complication of hypothermic cardiopulmonary bypass. Although this is believed to be caused by cold injury to the phrenic nerve, its exact cause is still not clear. STUDY OBJECTIVE: To assess feasibility, safety, and usefulness of intraoperative phrenic nerve function monitoring. SETTING: Elective cardiac surgery in a university hospital. PATIENTS: Consenting patients scheduled for myocardial revascularization surgery with the use of the left internal mammary artery. DESIGN: Intraoperative monitoring of compound diaphragmatic action potentials (CDAPs) through transcutaneous stimulation of phrenic nerves. INTERVENTIONS: Patients were divided in two groups. Group 1 received intracoronary cold St. Thomas's solution as the only cardioplegic method. Group 2 received topical cardiac cooling with ice-cold solutions in addition to intracoronary cardioplegia. RESULTS: In all group 1 patients, function of phrenic nerves was maintained throughout the surgical procedure. Group 2: in two patients, bilateral, and in one patient, left phrenic nerve conduction was abolished after submersion of the heart in ice-cold solution. In two of them, the action potential of the left hemidiaphragm was absent by the end of surgery. In one, nerve conduction recovered with rewarming of the patient. DISCUSSION: Intraoperative monitoring of CDAP was safe and easily obtained in the intraoperative setting. It allowed us to observe changes in phrenic nerve conduction occurring during surgery and as a result of cold cardioplegia. Cryogenic lesion of phrenic nerve might explain our findings. However, nerve ischemia cannot be ruled out and it may worsen axonal damage or delay its recovery. COMMENT: This monitoring method allowed us to predict postoperative diaphragmatic dysfunction. Also, surgeons can be warned of the damaging effects of excessive cooling of the pericardium and surrounding structures; thus, preventive measures can be taken.

Action Potentials↗

PubMed2006

Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms.

PURPOSE: The endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) with a bilateral common iliac artery aneurysm (CIAA) often requires exclusion of the bilateral hypogastric artery (HA), which can be associated with pelvic ischemic complications such as erectile dysfunction and buttock claudication. This study assessed the effect of HA bypass on improving pelvic circulation. METHODS: Five patients who underwent endovascular repair with HA bypass for an AAA with bilateral CIAA were evaluated. In all patients, the patency of the inferior mesenteric artery and bilateral HAs arteries was confirmed with preoperative computed tomography (CT) scans and angiography. During EVAR, penile blood flow was monitored with pulse-volume plethysmography measuring the penile brachial pressure index (PBI), and bilateral buttock blood flow was monitored with near-infrared spectroscopy measuring the gluteal tissue oxygenation index (TOI). An aortouni-external iliac artery stent graft with a crossover bypass was performed after embolization of the contralateral HA. HA bypass was performed between the crossover bypass graft and the ipsilateral HA via a retroperitoneal incision. RESULTS: Unilateral coil embolization of the contralateral side HA trunk slightly decreased blood flow to the contralateral side buttock but did not cause significant changes in penile blood flow. At the completion of EVAR, the levels of both PBI and the contralateral side TOI were significantly lower than the baseline levels. After ipsilateral side HA revascularization with HA bypass, both PBI and bilateral gluteal flow returned almost to the baseline levels. Postoperative angiography and CT scans demonstrated the patency of all HA bypasses and no endoleaks. None of the patients experienced new onset of erectile dysfunction or buttock claudication 1 month after surgery. CONCLUSION: Bilateral HA interruption during EVAR for AAA with bilateral CIAA was associated with significant depletion of both penile and gluteal blood flow. Intraoperative monitoring of PBI and TOI at the bilateral buttocks showed significant improvement of both parameters after HA bypass. HA bypass is an excellent procedure to improve pelvic circulation despite its increased surgical complexity.

Aged↗

PubMed1994

Clinical application of evoked spinal cord potentials elicited by direct stimulation of the cord during temporary occlusion of the thoracic aorta.

Evoked spinal cord potentials elicited by direct stimulation of the cord were used to monitor spinal cord ischemia in 68 patients undergoing temporary occlusion of the thoracic aorta (29 thoracic nondissecting aortic aneurysms, 9 nondissecting thoracoabdominal aneurysms, and 30 dissecting aneurysms). "Immediate" postoperative paraplegia developed in three patients and "immediate" paraparesis developed in one, whereas "delayed" paraplegia developed in two others. During aortic crossclamping, four response patterns of the spinal cord potentials were obtained: (1) no change (n = 53), (2) change with return (n = 10), (3) change with inconsistent return (n = 2), and (4) change without return (n = 3). Neurologic complications occurred in 2%, 0%, 100% of these groups, respectively. Delayed paraplegia developed on the second postoperative day in only one patient with a false-negative result, and the potentials correlated well with this patient's clinical neurologic recovery. The aortic crossclamp time was significantly longer in the patients with "change with inconsistent return" and "change without return" than in the other two groups (p < 0.01). Femoral artery pressure and the cardiopulmonary bypass flow rate were also significantly lower in these groups than in the other two groups (p < 0.02 and p < 0.01, respectively). We conclude that intraoperative monitoring of direct spinal cord responses is useful for the early detection of spinal cord ischemia for assessing the efficacy of surgical countermeasures.

Aortic Dissection↗

PubMed1992

Arterial imaging.

Angioscopy, magnetic resonance angiography, computed tomography, and nuclear medicine are assuming an increasingly important role in arterial imaging. This review discusses recent advances in these modalities. Angioscopy has proven valuable in monitoring intraoperative surgical procedures as well as percutaneous interventions. Carotid artery magnetic resonance angiography is gaining increasing acceptance in clinical practice. Magnetic resonance angiography of the peripheral arteries is limited by spatial resolution and signal loss distal to the stenosis. The role of computed tomography in limiting the number of aortograms performed in evaluating aortic laceration remains controversial; however, several recent papers indicate its usefulness in evaluating clinically stable patients with abnormal chest radiographs. Computed tomography of abdominal aortic aneurysms may obviate the need for preoperative aortography in the majority of cases. Nuclear imaging for deep venous thrombosis using 111In-labeled antifibrin monoclonal antibodies was shown highly sensitive in its initial report.

Adult↗