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https://www.readbyqxmd.com/read/29153782/outcomes-of-cervical-laminoplasty-population-level-analysis-of-a-national-longitudinal-database
#1
Anand Veeravagu, Tej D Azad, Michael Zhang, Amy Li, Arjun V Pendharkar, John K Ratliff, Lawrence M Shuer
OBJECTIVE: Cervical laminoplasty is an important alternative to laminectomy in decompressing of the cervical spine. Further evidence to assess the utility of laminoplasty is required. We examine outcomes of cervical laminoplasty via a population level analysis in the United States. METHODS: We performed a population-level analysis using the national MarketScan longitudinal database to analyze outcomes and costs of cervical laminoplasty between 2007 and 2014. Outcomes included postoperative complications, revision rates, and functional outcomes...
November 15, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29142846/opportunities-and-challenges-of-intermittent-and-continuous-intraoperative-neural-monitoring-in-thyroid-surgery
#2
REVIEW
Rick Schneider, Andreas Machens, Gregory W Randolph, Dipti Kamani, Kerstin Lorenz, Henning Dralle
The number of thyroid operations and there radically continues to rise in the western hemisphere, bringing prevention of recurrent laryngeal nerve (RLN) palsy to the fore. Overall, the incidence of RLN palsy is fairly low but continues to prompt litigation for malpractice. In an effort to diminish transient, and more importantly permanent, RLN palsy rates, intraoperative neuromonitoring (IONM) has been advocated as a risk minimization tool. Recent meta-analyses of studies, many of which were limited by poor study design and the sole use of intermittent nerve stimulation, were unable to demonstrate superiority of IONM over mere anatomic RLN dissection...
October 2017: Gland Surgery
https://www.readbyqxmd.com/read/29142836/preoperative-intraoperative-and-postoperative-anesthetic-prospective-for-thyroid-surgery-what-s-new
#3
REVIEW
I-Cheng Lu, I-Hua Lin, Che-Wei Wu, Hsiu-Ya Chen, Yi-Chu Lin, Feng-Yu Chiang, Pi-Ying Chang
The aim of this review is to analyze what's new on anesthetic prospective to perioperative management for thyroid surgery. For recent decades intraoperative neuromonitoring (IONM) during thyroid and parathyroid surgery has obtained more and more popularity. New modality of anesthetic technique was also developed to incorporate into surgical teamwork. For example, the precise position of EMG tube and optimal use of neuromuscular blocking agents (NMBAs) play key roles in successful IONM system. Special focus is paid to following issues: (I) preoperative airway evaluation and pre-op preparation; (II) anesthetic managements including advanced intubation tools, NMBAs and sugammadex; and (III) post-op adverse events such as pain and postoperative nausea vomiting...
October 2017: Gland Surgery
https://www.readbyqxmd.com/read/29142834/two-stage-thyroidectomy-in-the-era-of-intraoperative-neuromonitoring
#4
Christos Christoforides, Ioannis Papandrikos, Georgios Polyzois, Nikolaos Roukounakis, Gianlorenzo Dionigi, Kyriakos Vamvakidis
Background: The use of intraoperative neuromonitoring (IONM) provides surgeons with real time information about recurrent laryngeal nerves (RLN) functional integrity. Hence, allowing them to modify the initially scheduled bilateral procedure, to a two-stage thyroidectomy in cases of loss of signal (LOS) on the first side of resection resulting in minimization of bilateral RLN injury. The purpose of our study was to present our results since the implementation of the above mentioned process in both malignant and benign thyroid disease...
October 2017: Gland Surgery
https://www.readbyqxmd.com/read/29136734/-functional-recovery-after-recurrent-laryngeal-nerve-injury-on-different-electromyography-thresholds-during-thyroid-surgery
#5
X L Liu, C L Li, Y S Zhao, H Sun
Objective: To discuss the functional recovery after recurrent laryngeal nerve injury (RLNI) on different electromyography thresholds during thyroid surgery. Methods: The prospective experimentally were induced in 12 acute recurrent laryngeal traction animals (porcine) from December 2014 to December 2015, the amplitude and latency of electromyography, even time course during RLNI and recovery of 24 recurrent laryngeal nerves(RLN) were continuous intraoperative neuromonitoring(IONM), including 12 RLN releasing traction after 50% amplitude decrease (AD) and other 12 RLN after 70% AD...
November 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/29132507/management-of-traumatic-brain-injury
#6
REVIEW
Justin R Davanzo, Emily P Sieg, Shelly D Timmons
Traumatic brain injury remains a serious public health problem, causing death and disability for millions. In order to maximize outcomes in the face of a complex injury to a complex organ, a variety of advanced neuromonitoring techniques may be used to guide surgical and medical decision-making. Because of the heterogeneity of injury types and the plethora of treatment confounders present in this patient population, the scientific study of specific interventions is challenging. This challenge highlights the need for a firm understanding of the anatomy and pathophysiology of brain injuries when making clinical decisions in the intensive care unit...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29132382/early-motor-function-after-local-treatment-of-brain-metastases-in-the-motor-cortex-region-with-stereotactic-radiotherapy-radiosurgery-or-microsurgical-resection-a-retrospective-study-of-two-consecutive-cohorts
#7
Bogdan Pintea, Brigitta Baumert, Thomas Mehari Kinfe, Konstantinos Gousias, Yaroslav Parpaley, Jan Patrick Boström
BACKGROUND: We compared the functional outcome and influential factors of two standard treatment modalities for central cerebral metastases: electrophysiological-controlled microsurgical resection (MSR) and stereotactic radiotherapy/stereotactic radiosurgery (SRT/SRS). METHODS: We performed a database search for central metastasis treatments during the period from January 2008 to September 2012 in two clinical registers: 1) register for intraoperative neuromonitoring (Department of Neurosurgery), and 2) prospective database for SRT/SRS (Department of Radiotherapy)...
November 13, 2017: Radiation Oncology
https://www.readbyqxmd.com/read/29128183/does-intraoperative-neuromonitoring-of-recurrent-nerves-have-an-impact-on-the-postoperative-palsy-rate-results-of-a-prospective-multicenter-study
#8
Éric Mirallié, Cécile Caillard, François Pattou, Laurent Brunaud, Antoine Hamy, Marcel Dahan, Michel Prades, Muriel Mathonnet, Gérard Landecy, Henri-Pierre Dernis, Jean-Christophe Lifante, Frederic Sebag, Franck Jegoux, Emmanuel Babin, Alain Bizon, Florent Espitalier, Isabelle Durand-Zaleski, Christelle Volteau, Claire Blanchard
BACKGROUND: The impact of intraoperative neuromonitoring on recurrent laryngeal nerve palsy remains debated. Our aim was to evaluate the potential protective effect of intraoperative neuromonitoring on recurrent laryngeal nerve during total thyroidectomy. METHODS: This was a prospective, multicenter French national study. The use of intraoperative neuromonitoring was left at the surgeons' choice. Postoperative laryngoscopy was performed systematically at day 1 to 2 after operation and at 6 months in case of postoperative recurrent laryngeal nerve palsy...
November 8, 2017: Surgery
https://www.readbyqxmd.com/read/29119329/a-functional-assessment-of-anatomical-variants-of-the-recurrent-laryngeal-nerve-during-thyroidectomies-using-neuromonitoring
#9
Beata Wojtczak, Krzysztof Kaliszewski, Krzysztof Sutkowski, Marek Bolanowski, Marcin Barczyński
PURPOSE: The aim of the study was to assess the usefulness of intraoperative neuromonitoring (IONM) in identifying anatomical variants of the recurrent laryngeal nerve (RLN) during thyroidectomies, with emphasis on the nerve's relationship to the inferior thyroid artery (ITA), Zuckerkandl's tubercle, nonrecurrent laryngeal nerves (NRLNs), and extralaryngeal bifurcation. METHODS: A total of 128 subjects undergoing surgery for thyroid disorders were enrolled in the study, and the course and anatomical variants of RLN were assessed with IONM application...
November 8, 2017: Endocrine
https://www.readbyqxmd.com/read/29111396/limitations-and-pitfalls-of-the-pedicle-screw-testing-monitoring-technique-an-in-vivo-and-in-vitro-study
#10
Julie Zyss, Isabelle Bernat, Stéphane Wolff, Guillaume Riouallon, Hugues Pascal-Moussellard
OBJECTIVES: Pedicle screw testing is a widely used technique in the field of neuromonitoring for spinal surgery. It was designed by Calancie et al. (1992) in order to detect pedicle breach, one of the major complications of pedicle screw fixation, which can lead to neurological impairment. However, numerous false negative and equivocal results led to its clinical relevance being questioned. We aimed to clarify these discrepancies and characterize electrical parameters underlying this technique...
October 27, 2017: Neurophysiologie Clinique, Clinical Neurophysiology
https://www.readbyqxmd.com/read/29110082/continuous-monitoring-of-the-recurrent-laryngeal-nerve
#11
Aitor De la Quintana Basarrate, Arantza Iglesias Martínez, Iciar Salutregui, Leire Agirre Etxabe, Ainhoa Arana González, Izaskun Yurrebaso Santamaría
OBJECTIVE: The objective of this study was to assess the safety and utility of continuous intraoperative neuromonitoring for the prevention of recurrent laryngeal nerve injury during thyroidectomy. METHODS: A prospective cohort study was conducted in consecutive patients undergoing thyroidectomy. Variations in amplitude and distal latency of the electromyogram (EMG) were assessed. In the case of suspicious events, restorative manoeuvers were performed to attempt to recover the potentials...
November 6, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/29088949/unraveling-the-complexities-of-invasive-multimodality-neuromonitoring
#12
Saurabh Sinha, Eric Hudgins, James Schuster, Ramani Balu
Acute brain injuries are a major cause of death and disability worldwide. Survivors of life-threatening brain injury often face a lifetime of dependent care, and novel approaches that improve outcome are sorely needed. A delayed cascade of brain damage, termed secondary injury, occurs hours to days and even weeks after the initial insult. This delayed phase of injury provides a crucial window for therapeutic interventions that could limit brain damage and improve outcome. A major barrier in the ability to prevent and treat secondary injury is that physicians are often unable to target therapies to patients' unique cerebral physiological disruptions...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29084196/multi-modality-neuromonitoring-in-severe-pediatric-traumatic-brain-injury-monitoring-pediatric-tbi
#13
REVIEW
Adam M H Young, Mathew R Guilfoyle, Joseph Donnelly, Peter Smielewski, Shruti Agarwal, Marek Czosnyka, Peter J Hutchinson
Each year, the annual hospitalization rates of traumatic brain injury (TBI) in children in the US are 57.7 per 100 K less than 5 years of age and 23.1 per 100 K in the 5-14 year age group. Despite this, little is known about the pathophysiology of TBI in children and how to manage it most effectively. Historically, TBI management has been guided by clinical examination. This has been assisted progressively by clinical imaging, intracranial pressure (ICP) monitoring and finally software that can calculate optimal brain physiology...
October 30, 2017: Pediatric Research
https://www.readbyqxmd.com/read/29075879/epidural-balloon-placement-for-protection-of-the-spinal-canal-during-cryoablation-of-paraspinal-lesions
#14
Jeffrey Forris Beecham Chick, Ravi N Srinivasa, Evan Johnson, Matthew L Osher, Anthony Hage, Joseph J Gemmete
Ablation of paraspinal lesions close to the spinal canal and neuroforamina requires protective measures in order to protect the spinal cord and nerve roots. Various methods of protection have been previously described including infusion of saline and CO2. Regardless, neuromonitoring should be adjunctively performed when ablating spinal lesions close to neuronal structures. Balloon protection has been previously described during ablation of renal masses. The benefit of balloon protection in paraspinal mass ablation is it physically displaces the nerve roots as opposed to CO2 or saline which has the potential to insulate but because of its aerosolized or fluid nature may or may not provide definitive continuous protection throughout an ablation...
October 26, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/29052179/thyroid-reoperation-using-intraoperative-neuromonitoring
#15
Beata Wojtczak, Krzysztof Sutkowski, Krzysztof Kaliszewski, Marcin Barczyński, Marek Bolanowski
PURPOSE: Thyroid reoperations are at a high risk of recurrent laryngeal nerve (RLN) injury. The aim of the study was to investigate whether the use of intraoperative neuromonitoring (IONM) can aid in the RLN identification and minimize the risk of its injury, in comparison with visual RLN identification. METHODS: This was a retrospective cohort study of patients who underwent thyroid reoperations with and without the use of IONM. Primary endpoint was the RLN identification rate; secondary: the prevalence of RLN injury, the frequency of total thyroidectomies, and the course of the RLN...
October 19, 2017: Endocrine
https://www.readbyqxmd.com/read/29049087/raising-mean-arterial-pressure-alone-restores-20-of-intraoperative-neuromonitoring-losses
#16
Joshua Yang, David L Skaggs, Priscella Chan, Suken A Shah, Michael G Vitale, Geraldine Neiss, Nicholas Feinberg, Lindsay M Andras
STUDY DESIGN: Multicenter prospective. OBJECTIVE: To assess the effect of intraoperative interventions in restoring intraoperative neuromonitoring (IONM) signals in pediatric spine surgery. SUMMARY OF BACKGROUND DATA: No prior studies have prospectively examined the rate of return of IONM signals by increasing blood pressure (BP) alone. METHODS: Patients undergoing posterior spinal deformity surgery were enrolled at their preoperative appointment...
October 18, 2017: Spine
https://www.readbyqxmd.com/read/29034255/perioperative-management-of-elderly-patients-with-gastrointestinal-malignancies-the-contribution-of-anesthesia
#17
REVIEW
Rudolf Mörgeli, Kathrin Scholtz, Johannes Kurth, Sascha Treskatsch, Bruno Neuner, Susanne Koch, Lutz Kaufner, Claudia Spies
INTRODUCTION: Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. METHODS: We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities...
August 2017: Visceral Medicine
https://www.readbyqxmd.com/read/29032754/pharmacological-neuroprotection-in-cardiac-surgery-effectiveness-of-pharmacologic-preconditioning-with-erythromycin
#18
Charilaos-Panagiotis C Koutsogiannidis, Elizabeth O Johnson
Regardless of the degree of advances in neuroprotective strategies, and despite the technological progress in neuromonitoring, brain injury still remains the "Achilles' heel" in cardiac surgery. A large number of pharmacological and non-pharmacological therapeutic interventions have been investigated during the last two decades. Recently, both theoretical and experimental findings suggest benefits of pharmacological cerebral protection, although, there is no conclusive evidence of clinical superiority of specific agents that have been applied as neuroprotectants, in human randomized controlled trials...
October 10, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/29030215/analyzing-cost-effectiveness-of-neural-monitoring-in-recurrent-laryngeal-nerve-recovery-course-in-thyroid-surgery
#19
Tie Wang, Hoon Yub Kim, Che-Wei Wu, Stefano Rausei, Hui Sun, Francesca Pia Pergolizzi, Gianlorenzo Dionigi
PURPOSE: The increasing use of intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgery imposes an evaluation of cost-effectiveness. METHODS: The analysis estimated the cost versus utility of different alternatives that simulate nerve injury course and the consequences for the following cohorts of patients: (1) no RLN injury, or vocal fold palsy (VCP) recovery within 1 month (2), 2 months (3), 6 months (4), and after 12 months (5)...
October 10, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/29023306/medical-error-avoidance-in-intraoperative-neurophysiological-monitoring-the-communication-imperative
#20
Stan Skinner, Robert Holdefer, John J McAuliffe, Francesco Sala
Error avoidance in medicine follows similar rules that apply within the design and operation of other complex systems. The error-reduction concepts that best fit the conduct of testing during intraoperative neuromonitoring are forgiving design (reversibility of signal loss to avoid/prevent injury) and system redundancy (reduction of false reports by the multiplication of the error rate of tests independently assessing the same structure). However, error reduction in intraoperative neuromonitoring is complicated by the dichotomous roles (and biases) of the neurophysiologist (test recording and interpretation) and surgeon (intervention)...
November 2017: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
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