Cyber medicine enables remote neuromonitoring during aortic surgery

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Remote neuromonitoring of spinal cord function during aortic surgery is feasible and reliable, Michael Jacobs, European Vascular Center Aachen-Maastricht, Department of Surgery, Maastricht, The Netherlands, told delegates at the Vascular Annual Meeting (Chicago, USA).

Jacobs presented data of a study which investigated reliability, stability and robustness of a telemedical system for remote neuromonitoring during aortic surgery.

 

“Neuromonitoring of spinal function by detecting motor evoked potentials (MEPs) during open repair of thoracoabdominal aortic aneurysms is a valid method to assess insufficient arterial supply to alpha motor neurons,” he said. “This method requires a complex technique and specific neurophysiological expertise. We demonstrate how four European vascular centres resort to one technical infrastructure and neuromonitoring-expertise during thoracoabdominal aortic aneurysm open repair by Internet connection.”

In 2009 and 2010, 121 patients were treated by thoracoabdominal aortic aneurysms open repair using identical protocols, including distal aortic perfusion.

 

“All neurophysiological data from two centres in Germany, one in Switzerland and one in The Netherlands were evaluated by a central neurophysiologists team in a Dutch medical centre. Online assessment of MEPs was installed using internet with Virtual Private Network Tunnelling,” Jacobs said.

The results of the investigation have showed that MEPs were monitored in all patients without technical problems. In 61 patients a significant drop in MEPs was recorded, requiring immediate protective adjustments. In 30 patients, blood pressure management, reposition of cross-clamps, blocking of intercostal arteries or rewarming restored MEPs. All other cases required re-attachment of spinal cord supplying arteries. In 59 patients the protective strategies corrected MEPs completely. In all cases the data communication was stable enabling successful MEPs evaluation by the neurophysiologist in The Netherlands.

Jacobs concluded that remote neuromonitoring of spinal cord function allows centralisation of expertise and saves individual centres to invest in complex technology.

 

“The value of monitoring MEPs was confirmed in different centers, resulting in adequate neurological outcome following extensive aortic procedures,” he stated.