Tehnike zaštite kralješnične moždine tijekom aorte

master's thesis

• Title (english): Methods for spinal cord protection during aortic surgery
• Author: Anđelo Kaštelančić
• Mentor: Mladen Petrunić (mentor)
• Committee member: Tomislav Luetić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Mladen Petrunić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Paraplegija i parapareza su dvije devastirajuće komplikacije koje se javljaju nakon operacije aneurizme aorte, a posljedica su ishemije kralješnične moždine. Glavni uzroci nastanka ishemijske ozljede kralješnične moždine su: 1) trajanje i stupanj ishemije, 2) neuspjeh ponovnog uspostavljanja krvotoka prema kralješničnoj moždini i 3) biokemijski posredovana reperfuzijska ozljeda. Brojne strategije su razvijene s ciljem smanjenja incidencije neurološkog deficita nakon kirurgije aorte. Razvoj... More kirurških tehnika išao je u smjeru smanjenja trajanja ishemije. Distalna aortna perfuzija koristi se radi redukcije stupnja ishemije, dok se hipotermijom i raznim farmakološkim tvarima nastoji povećati tolerancija kralješnične moždine na ishemiju. Perfuzija kralješnične moždine postiže se drenažom cerebrospinalne tekućine, kao i regulacijom srednjeg arterijskog tlaka. Intraoperativnim monitoriranjem evociranih potencijala utvrđuju se kritične segmentalne arterije koje se koriste za reimplantaciju radi prevencije ishemijske ozljede kralješnične moždine. Preoperativna identifikacija Adamkiewiczeve arterije također omogućava identifikaciju segmentalnih arterija koje se koriste za reimplantaciju, rezultirajući ponovnom uspostavom krvotoka prema kralješničnoj moždini. Razvojem endovaskularnih tehnika omogućena je redukcija postoperativnih ishemijskih komplikacija posebice u visoko rizičnih pacijenata koji nisu prikladni za primjenu otvorenih kirurških tehnika. Usprkos svim navedenim tehnikama rekonstruktivna kirurgija torakoabdominalne aorte ostaje velik izazov za kirurge, međutim sve bolje poznavanje patofiziologije ishemije kralješnične moždine pruža nadu za daljnju borbu protiv ishemijskih komplikacija tijekom kirurgije aorte. Less

Abstract (english)

Paraplegia and paraparesis are two devastating complications that occur after aortic aneurysm surgery repair as a consequence of ischemic spinal cord injury. The main causes of ischemic spinal cord injury are: 1) the duration and degree of ischemia, 2) failure to re-establish blood flow to spinal cord and 3) biochemically mediated reperfusion injury. Numerous strategies have been developed to reduce the incidence of neurological deficit after aortic surgery. Some surgical techniques were... More designed to reduce the duration of ischemia. Distal aortic perfusion has been used in order to reduce the degree of ischemia, while hypothermia and various pharmacological agents have been used to increase the tolerance of the spinal cord to ischemia. Spinal cord perfusion has been achieved by cerebrospinal fluid drainage, as well as the regulation of mean arterial pressure. Intraoperative monitoring of evoked potentials has been used to identify critical segmental arteries used for reimplantation for the prevention of ischemic spinal cord injury. Preoperative identification of the Adamkiewicz artery also allows the identification of segmental arteries used for reimplantation, resulting in the restoration of blood flow to spinal cord. The development of endovascular techniques enabled the reduction of postoperative ischemic complications especially in high-risk patients who were not fit enough to undergo open surgery. Despite all of the above techniques thoracoabdominal aortic reconstructive surgery remains a major challenge for surgeons, however, better understanding of the pathophysiology of spinal cord ischemia provides hope for further combat against ischemic complications during aortic surgery. Less

• Keywords: paraplegija; parapareza; aneurizma aorte; ishemija; kralješnična moždina
• Keywords (english): paraplegia; paraparesis; aortic aneurysm; ischemia; spinal cord
• Language: croatian
• URN:NBN: urn:nbn:hr:105:739395
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-10-26 12:03:00