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Spinales und paraspinales Kollateralnetzwerk

Rückenmarkperfusion und Neuroprotektion

Spinal and paraspinal collateral network

Spinal cord perfusion and neuroprotection

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Komplexe Operationen an der thorakalen und thorakoabdominalen Aorta gehören zu den technisch anspruchsvollsten Eingriffen in der Herzchirurgie und sind nach wie vor mit einer erhöhten Morbidität und Letalität assoziiert. Die perioperative Paraplegie aufgrund ischämischer Rückenmarkschädigung stellt hierbei eine der für den Patienten schicksalhaftesten Komplikationen dar. Trotz der Entwicklung zahlreicher neuroprotektiver Strategien hat die Inzidenz der ischämischen Rückenmarkschädigung bei offenen und endovaskulären Operationen an der thorakalen und thorakoabdominalen Aorta jedoch nur geringfügig abgenommen. Zur erfolgreichen Entwicklung und klinischen Anwendung von effektiven neuroprotektiven Strategien bei aortenchirurgischen Eingriffen ist zwangsläufig ein dezidiertes Verständnis der Anatomie der rückenmarkversorgenden Gefäße erforderlich. Neu gewonnene experimentelle und klinische Erkenntnisse zur Rückenmarkprotektion erlaubten die Entwicklung der Hypothese des paraspinalen und spinalen Kollateralnetzwerks („collateral network“, CN), die die klassische Theorie der Adamkiewicz-Arterie zunehmend infrage stellt sowie gleichzeitig neue Therapieansätze und Strategien zur Rückenmarkprotektion ermöglichen könnte. Die vorliegende Arbeit gibt einen Überblick über die neuesten klinischen und experimentellen Erkenntnisse hinsichtlich des arteriellen paraspinalen und spinalen CN sowie über die derzeit angewendeten neuroprotektiven Strategien zur Verhinderung von Paraplegien nach Operationen an der deszendierenden thorakalen Aorta (DTA) und thorakoabdominalen Aorta (TAA).

Abstract

Extensive thoracic and thoracoabdominal aortic repair remains one of the most challenging operations in cardiovascular surgery and is still associated with increased morbidity and mortality. Perioperative paraplegia due to ischemic spinal cord injury remains one of most dreaded complications in aortic surgery. Despite the clinical implementation of several neuroprotective strategies the incidence of ischemic spinal cord injury during thoracic and thoracoabdominal aortic repair remains high. However, definitive knowledge of the spinal cord vasculature, the feeding arterial branches and the underlying physiology is imperative to allow successful development of effective neuroprotective strategies during aortic surgery. Recent experimental and clinical data on spinal cord protection has resulted in the development of the collateral network concept that currently challenges the classical theory on spinal cord blood supply by the Adamkiewicz artery. However, this new theory of an extensive intraspinal and paraspinal collateral network may allow the development of new spinal cord protective strategies. This article discusses recent experimental and clinical studies regarding the collateral network concept of arterial spinal cord blood supply and gives an overview on the neuroprotective strategies currently used during aortic surgery.

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- Einhaltung der ethischen Richtlinien

Interessenkonflikt. M. Lühr, F.-W. Mohr und C.D. Etz geben an, dass kein Interessenkonflikt besteht. Der korrespondierende Autor bestätigt, dass alle nationalen Richtlinien zur Haltung und zum Umgang mit Labortieren eingehalten wurden und die notwendigen Zustimmungen der zuständigen Behörden vorliegen.

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  1. Klinik für Herzchirurgie, Herzzentrum Leipzig – Universitätsklinik, Strümpellstr. 39, 04289, Leipzig, Deutschland

    M. Lühr, F.-W. Mohr &  C.D. Etz

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  1. M. Lühr
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  2. F.-W. Mohr
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  3. C.D. Etz
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Correspondence to C.D. Etz.

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Lühr, M., Mohr, FW. & Etz, C. Spinales und paraspinales Kollateralnetzwerk. Z Herz- Thorax- Gefäßchir 27, 424–433 (2013). https://doi.org/10.1007/s00398-012-0987-6

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