Abstract
A 69-year-old woman with back pain was admitted to our hospital 3 months previously due to a type-A acute aortic dissection with megaaorta syndrome. The aortic aneurysm extended from the ascending aorta to the bilateral iliac arteries. Initially, a total arch replacement with elephant trunk installation and an abdominal aortic aneurysm repair were performed simultaneously. One month after the first stage operation, the thoracoabdominal aortic aneurysm was repaired, applying distal perfusion, mild hypothermia, CSF drainage, segmental aortic clamping, reconstruction of intercostal and lumbar arteries, and edaravone for spinal cord protection. Transcranial motor evoked potentials (tc-MEP) were monitored during the operation. Although tc-MEPs disappeared due to spinal cord ischemia during aortic cross-clamping, the amplitude of tc-MEP recovered after hypertension treatment and a quick reattachment of the intercostal arteries. The 8th, 10th and 11th intercostal arteries and the 1st lumbar artery were reconstructed. This patient was discharged 20 days postoperatively without any neurologic deficit.
