Epidural cooling. Neuroprotective treatment of thoracoabdominal aortic aneurysms

The risk of paraplegia and paraparesis during thoracoabdominal aneurysm surgery still represents a major threat. In 1993, Cambria and coworkers applied for the first time a method of regional spinal cord hypothermia by epidural cooling and significantly diminished the rate of neurological deficits. In this article the first clinical application of this neuroprotective method in Germany will be reported. This neuroprotective method was used in seven patients who underwent elective thoracoabdominal aortic aneurysm repair. The spinal cord was cooled with ice-cold saline via an epidural catheter during surgical repair. Cerebrospinal fluid pressure was measured on-line via a spinal catheter and controlled using active cerebrospinal fluid drainage. Of these seven patients, four showed no postoperative neurological deficit and were released from hospital. The other three patients died in the intra-operative or post-operative phase due to complications other than spinal cord injury arising from pre-existing comorbid conditions. The described method of epidural cooling represents a preliminary experimental method, which might reduce spinal cord injury during surgical repair of thoracoabdominal aneurysms.