# Motor-Evoked Potential Monitoring With Multi-train Electrical Stimulation During Thoracoabdominal Aortic Aneurysm Surgery: A Case Report

## TL;DR

This case report shows that using multi-train electrical stimulation improves motor-evoked potential monitoring during complex aortic surgery when standard methods fail.

## Contribution

Demonstrates the effectiveness of multi-train stimulation for MEP monitoring in thoracoabdominal aortic aneurysm surgery under challenging conditions.

## Key findings

- Multi-train stimulation successfully elicited MEPs when single-train stimulation failed during surgery.
- MEPs were consistently recorded in lower extremity muscles using multi-train stimulation until the end of the procedure.
- This case suggests multi-train stimulation can be a reliable alternative in difficult intraoperative monitoring scenarios.

## Abstract

Intraoperative motor-evoked potentials (MEPs) are measured for assessing motor function during surgery. MEP monitoring is often performed in thoracoabdominal aortic aneurysm (TAAA) surgery, but false positives are common and amplification methods are needed to obtain waveforms under severe conditions to assess proper spinal cord function. One method of amplitude amplification in transcranial-stimulated MEP monitoring is multitrain stimulation. There are few reports on multitrain-stimulated MEP monitoring for this surgery. A 57-year-old woman underwent open repair of the thoracoabdominal aorta due to a dissecting aortic aneurysm. After opening the chest, the aneurysm was incised proximally, and anastomosis with an artificial vessel was initiated. The lumbar artery leading to the Adam-Kiewicz artery was reconstructed at a body temperature of 25 °C. However, the single-train stimulation did not produce MEPs. When the measurement was switched to multitrain stimulation, MEPs were elicited in the lower extremity muscle groups and the waveforms were maintained until the end of the measurement. This case illustrates that MEP monitoring using multitrain stimulation during descending thoracic aortic aneurysm surgery can effectively elicit MEPs under challenging conditions, in which conventional single-train stimulation may be insufficient.