Bipolar transesophageal thoracic spinal cord stimulation: A novel clinically relevant method for motor-evoked potentials.
MEP, motor evoked potential
TC, transcranial
TE, transesophageal
aortic surgery
biTE, bipolar transesophageal
monoTE, monopolar transesophageal
motor evoked potentials
spinal cord ischemia
transesophageal stimulation
Journal
JTCVS techniques
ISSN: 2666-2507
Titre abrégé: JTCVS Tech
Pays: United States
ID NLM: 101768546
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
03
08
2020
revised:
03
08
2020
accepted:
10
08
2020
entrez:
28
7
2021
pubmed:
29
7
2021
medline:
29
7
2021
Statut:
epublish
Résumé
Although transesophageal motor-evoked potential elicited by monopolar cervical cord stimulation is more stable and rapid in response to ischemia than transcranial motor-evoked potential in canine experiments, direct cervical alpha motor neuron stimulation precludes clinical application. We evaluated a novel stimulation method using a bipolar esophageal electrode to enable thoracic cord stimulation. Twenty dogs were anesthetized. For bipolar transesophageal stimulation, the interelectric pole distance was set at 4 cm. Changes in amplitude in response to incremental stimulation intensity (100-600 V) were measured to evaluate stability. Spinal cord ischemia was induced by aortic balloon occlusion at the T8 to T10 level for 10 minutes to evaluate response time or at the T3 to T5 level for 25 minutes to evaluate prognostic value. Neurological function was evaluated using the Tarlov score at 24 and 48 hours postoperatively. Bipolar transesophageal stimulation was successful in all animals and their forelimb waveforms were identical to those after transcranial stimulation. The minimum stimulation intensity to produce >90% of the maximum amplitude was significantly lower in both monopolar and bipolar transesophageal stimulation than in transcranial stimulation (n = 5). Time to disappearance and recovery (>75%) of the hindlimb potentials were significantly shorter by both monopolar and bipolar transesophageal stimulation than by transcranial stimulation (n = 5). Correlation with neurological outcomes was comparable among all stimulation methods (n = 10). Motor-evoked potential can be elicited by bipolar transesophageal thoracic cord stimulation without direct cervical alpha motor neuron stimulation, and its stability and response time are comparable to those elicited by monopolar stimulation.
Identifiants
pubmed: 34317958
doi: 10.1016/j.xjtc.2020.08.006
pii: S2666-2507(20)30381-3
pmc: PMC8303062
doi:
Types de publication
Journal Article
Langues
eng
Pagination
28-35Informations de copyright
© 2020 The Authors.
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