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Sungjoon Lee, Doo Young Kim, Su Bin Kim, Woojin Kim, Mi-Ri Kang, Hye-Jin Kim, Ki Hwa Lee, Minwook Yoo, Byung-Sam Choi, Jung Soo Kim, Sun-Il Lee, Hae Yu Kim, Sung-Chul Jin
PURPOSE: Forms of intraoperative neurophysiologic monitoring (IONM), including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), have been widely used in the field of neurosurgery. This study aimed to evaluate the diagnostic efficacy of IONM in identifying intraoperative events and predicting postoperative neurologic deficits in neurovascular intervention. METHODS: From January 2013 to December 2016, we retrospectively reviewed patients who underwent neurovascular intervention under general anesthesia with the use of IONM...
October 17, 2018: Neuroradiology
Go Yoshida, Muneharu Ando, Shiro Imagama, Shigenori Kawabata, Kei Yamada, Tsukasa Kanchiku, Yasushi Fujiwara, Nobuaki Tadokoro, Masahito Takahashi, Kanichiro Wada, Naoya Yamamoto, Sho Kobayashi, Hiroki Ushirozako, Kazuyoshi Kobayashi, Akimasa Yasuda, Kenichi Shinomiya, Toshikazu Tani, Yukihiro Matsuyama
STUDY DESIGN: Prospective multicenter study OBJECTIVE.: To analyze the incidence of intraoperative spinal neuromonitoring (IONM) alerts and neurological complications, as well as to determine which interventions are most effective at preventing postoperative neurological complications following IONM alerts in high risk spinal surgeries. SUMMARY OF BACKGROUND DATA: IONM may play a role in identifying and preventing neural damage; however, few studies have clarified the outcomes of intervention after IONM alerts...
October 11, 2018: Spine
Masami Yuda, Katsunori Nishikawa
Recurrent laryngeal nerve (RLN) palsy can result in motility disorders of the vocal cord muscles and/or fatal respiratory complications. Procedures aimed at checking for intraoperative RLN injuries have not been established. Intraoperative nerve monitoring( IONM) informs electromyographic activity of the vocal cord muscles to a surgeon by visual and aural signals. In this chapter, we introduce methods for using IONM during esophageal cancer surgery. Since we introduced IONM, several cases in which surgeons have had difficulty visually identifying the RLN have been reported...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Che-Wei Wu, Feng-Yu Chiang, Gregory W Randolph, Gianlorenzo Dionigi, Hoon Yub Kim, Yi-Chu Lin, Hui-Chun Chen, Hsiu-Ya Chen, Dipti Kamani, Tsung-Yi Tsai, I-Cheng Lu, Pi-Ying Chang
BACKGROUND: Intraoperative neural monitoring (IONM) has gained widespread acceptance as an adjunct to the gold standard of visual identification of the recurrent laryngeal nerve (RLN) during thyroid surgery. Currently, laryngeal electromyography (EMG) recording during IONM is almost always performed using endotracheal tube (ETT) surface electrodes placed adjacent to vocal folds originating from the inner surface of the thyroid cartilage (TC). Therefore, we hypothesized that surface recording electrodes placed on the outer surface of the TC should enable access to the EMG response of the vocal folds during IONM...
September 26, 2018: Thyroid: Official Journal of the American Thyroid Association
John P Ney, Daniel P Kessler
OBJECTIVES: Well-designed longitudinal studies assessing effectiveness of intraoperative neurophysiologic monitoring (IONM) are lacking. We investigate IONM effects on cost and administrative markers for health outcomes in the year after cervical spine surgery. METHODS: We identified single-level cervical spine surgeries in commercial claims. We constructed linear regression models estimating the effect of IONM (controlling for patient demographics, pre-operative health, services during index admission) on total spending, neurological complications, readmissions, and outpatient opiate usage in the year following index surgery...
August 29, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
In-Ho Jung, Kyeong-Wook Yoon, Young-Jin Kim, Sang Koo Lee
OBJECTIVE: Because the anatomical structure of the brachial plexus is very complex, surgical treatment of tumors in this region is challenging. Therefore, a lot of clinical and surgical experience is required for successful treatment; however, many neurosurgeons have difficulty accumulating this experience owing to the rarity of brachial plexus tumors. The purpose of this report is to share our surgical experience with brachial plexus tumor with other neurosurgeons. METHODS: The records of 18 consecutive patients with brachial plexus tumors who underwent surgical treatment between January 2010 and December 2017 in a single institution were retrospectively reviewed...
September 2018: Journal of Korean Neurosurgical Society
Che-Wei Wu, Hui Sun, Guang Zhang, Hoon Yub Kim, Antonina Catalfamo, Mattia Portinari, Paolo Carcoforo, Gregory W Randolph, Young Jun Chai, Gianlorenzo Dionigi
Background: The increasing use of intraoperative neuromonitoring (IONM) in thyroid surgery has revealed the need to develop new strategies for cases in which a loss of signal (LOS) occurs on the first side of a planned total thyroidectomy. Objectives: This study reviews the experience of the authors in using IONM for planned total thyroidectomy after LOS on the first thyroid lobe. The aims were to estimate the incidence of LOS on the first side of resection and to compare intraoperative strategies applied after this event...
August 2018: Laryngoscope Investigative Otolaryngology
Ottavio Cavicchi, Luca Burgio, Eleonora Cioccoloni, Ottavio Piccin, Giovanni Macrì, Patrizia Schiavon, Gianlorenzo Dionigi
PURPOSE: To evaluate the reliability of intermittent intraoperative neuromonitoring (I-IONM) through recurrent laryngeal nerve (RLN) stimulation and laryngeal palpation in predicting postoperative vocal cord palsy and to examine the reliability of this technique in providing useful information in the decision to perform a staged surgery in initially planned total thyroidectomy. METHODS: This was a retrospective cohort study of patients who underwent thyroid surgery at the ENT Department of the University of Bologna from January 2014 to June 2017...
September 1, 2018: Endocrine
Catherine F Sinclair, Maria J Téllez, Sedat Ulkatan
BACKGROUND: Continuous vagal intraoperative neuromonitoring (IONM) currently requires placement of a vagal nerve electrode. Herein, we present data from 100 patients (134 nerves-at-risk) monitored continuously during neck endocrine surgeries using a noninvasive, new methodology that solely utilizes endotracheal tube electrodes to simultaneously stimulate laryngeal mucosa and record a laryngeal adductor reflex continuous IONM (LAR-C-IONM) response. METHODS: The laryngeal adductor reflex (LAR) was elicited by electrical laryngeal mucosal stimulation on the side contralateral to the operative field using endotracheal tube electrodes...
August 18, 2018: Head & Neck
Jefferson Walter Daniel, Ricardo Vieira Botelho, Jerônimo Buzetti Milano, Fernando Rolemberg Dantas, Franz Jooji Onishi, Eloy Rusafa Neto, Eduardo de Freitas Bertolini, Marcelo Antonio Duva Borgheresi, Andrei Fernandes Joaquim
STUDY DESIGN: Systematic literature review and meta-analysis. OBJECTIVE: The objective of this systematic literature review was to evaluate if intraoperative neurophysiological monitoring (IONM) can prevent neurological injury during spinal operative surgical procedures. SUMMARY OF BACKGROUND DATA: IONM seems to have presumable positive effects in identifying neurological deficits. However, the role of IONM in the decrease of new neurological deficits remains unclear...
August 2018: Spine
Sanghyun Han, Yong Chul Kwon, Sung-Min Kim, Seung-Jae Hyun, Tae-Ahn Jahng, Ki-Jeong Kim, Hyun-Jib Kim, Ho Yong Choi, Young-Seop Park, Kyung Seok Park
OBJECTIVE: The aim of this study is to determine the risk factors affecting intraoperative neurophysiologic monitoring (IONM) changes, when such changes take place, and clinical outcomes associated with IONM change during cervical open door laminoplasty (COL) for cervical compressive myelopathy. METHODS: Between 2010 and 2015, 79 patients who underwent COL with IONM recording were studied. Changes in motor evoked potentials or somatosensory evoked potentials over an alarm criterion were defined as IONM change...
July 23, 2018: World Neurosurgery
Naresh Kumar, Vijayaraghavan G, Nivetha Ravikumar, Yan Ding, May Lin Yin, Ravish Shammi Patel, Nandika Naresh, Hwee Weng Hey Denis, Lau Leok Lim, Liu Ka Po Gabriel
STUDY DESIGN: Retrospective OBJECTIVE.: We aim to report our experience with multimodal Intraoperative neuromonitoring (IONM) in Metastatic Spine Tumour Surgery (MSTS). SUMMARY OF BACKGROUND DATA: IONM is considered as standard of care in spinal deformity surgeries. However, limited data exist about its role in MSTS. METHODS: A total of 135 patients from 2010 to 2017, who underwent MSTS with IONM at our institute were studied retrospectively...
July 23, 2018: Spine
Gunay Gurleyik, Mehmet Torun, Emin Gurleyik
Complication-free thyroid surgery is mainly based on the motor integrity of the recurrent laryngeal nerve (RLN). The nonrecurrent laryngeal nerve (non-RLN) is a rare anatomical variation that may increase the risk of vocal cord palsy. Early identification and exposure of the non-RLN may minimize injury risk. This case report presents functional detection of the non-RLN by intraoperative neuromonitoring (IONM). Total thyroidectomy was performed under the guidance of IONM on a patient with bulky multinodular goiter...
May 22, 2018: Curēus
Che-Wei Wu, Feng-Yu Chiang, Gregory W Randolph, Gianlorenzo Dionigi, Hoon Yub Kim, Yi-Chu Lin, Tzu-Yen Huang, Chiao-I Lin, Pao-Chu Hun, Dipti Kamani, Pi-Ying Chang, I-Cheng Lu
BACKGROUND: Recurrent laryngeal nerve (RLN) palsy remains a major source of morbidity after thyroid surgeries. Intraoperative neural monitoring (IONM) has gained increasing acceptance as an adjunct to standard practice of visual RLN identification. Endotracheal tube (ETT) surface recording electrodes systems are now widely used for IONM; however, a malpositioned ETT can cause false IONM results and requires time-consuming intraoperative verification of the ETT position and readjustment by the anesthesiologist...
August 24, 2018: Thyroid: Official Journal of the American Thyroid Association
Nan Zhang, Zhengda Yu, N U Farrukh Hameed, Geng Xu, Yanyan Song, Bin Wu, Jie Zhang, Tianming Qiu, Dongxiao Zhuang, Junfeng Lu, Jinsong Wu
OBJECTIVE: To evaluate long-term functional and survival outcomes of patients with glioma after intraoperative neurophysiologic monitoring (IONM) application. METHODS: A total of 856 patients with glioma, who underwent tumor resection between October 2010 and March 2016, were included in this retrospective cohort study. All patients were stratified into IONM (439 patients) and non-IONM groups (417 patients). The primary outcome measured was overall survival (OS), and the secondary outcome measured was rate of late neurologic deficits...
July 17, 2018: World Neurosurgery
Rogean R Nunes, Carlos D A Bersot, João G Garritano
PURPOSE OF REVIEW: The purpose of this review is to highlight the importance of making informed choices of anesthetics and evaluating the impact of depth of anesthesia, hemodynamic status and other factors capable of interfering with signal capture during intraoperative neurophysiological monitoring (IONM). RECENT FINDINGS: Over the last decades, neuromonitoring has advanced considerably, allowing for insights into neurological function during anesthesia and making it possible to assess intraoperative consciousness and neural integrity in real time...
October 2018: Current Opinion in Anaesthesiology
A F Engelsman, S Warhurst, S Fraser, D Novakovic, S B Sidhu
Background: Integrity of the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) can be checked by intraoperative nerve monitoring (IONM) after visualization. The aim of this study was to determine the prevalence and nature of voice dysfunction following thyroid surgery with routine IONM. Methods: Thyroidectomies were performed with routine division of strap muscles and nerve monitoring to confirm integrity of the RLN and EBSLN following dissection...
June 2018: BJS open
M W Pei, W B Chen, M R Hu
Recurrent laryngeal nerve (RLN) injury is a serious complication of thyroidectomy. Intraoperative neuro-monitoring(IONM) is a technology for identifying the integrity of nerves during operation by electrophysiological means, which included the intermitted IONM and the continuous IONM.This paper aims to compare the superiorities and defects of both IONM methods and summarize the current state and progress of IONM.
June 7, 2018: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
Daqi Zhang, Qingfeng Fu, Gianlorenzo Dionigi, Tie Wang, Jingwei Xin, Jiao Zhang, Gaofeng Xue, Hongbo Li, Hui Sun
OBJECTIVE: The aim of this report was dual: (a) to describe the step by step standardized intraoperative neural monitoring (IONM) procedure for recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve focusing on percutaneous IONM method, and (b) evaluation and outcomes of intermittent IONM in 237 endoscopic thyroidectomy via bilateral areolar approach cases. MATERIALS AND METHODS: A 10-mm curved incision is made along the margin of the right areola at the 2 to 4 o'clock position for the 30-degree endoscope...
October 2018: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Hiroyuki Kobayashi, Masato Kondo, Motoko Mizumoto, Hiroki Hashida, Satoshi Kaihara, Ryo Hosotani
BACKGROUND: Because the thoracic esophageal carcinoma has a high metastatic rate to the upper mediastinal lymph nodes, especially along the recurrent laryngeal nerves (RLN), it is crucial to perform a complete lymphadenectomy along the RLN without complications. Although intraoperative neural monitoring (IONM) during thyroid surgery has gained widespread acceptance as a useful tool for visual nerve identification, utilization of IONM during esophageal surgery has not become common. Here, we describe our procedures, focusing on a lymphadenectomy along the RLN utilizing the IONM...
August 2018: International Journal of Surgery
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