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Intraoperative Neurophysiologic Monitoring

Tuija Teerijoki-Oksa, Heli Forssell, Satu K Jääskeläinen
INTRODUCTION: We evaluated diagnostic value of sensory tests during recovery from iatrogenic sensory neuropathy using intraoperatively verified nerve injury with subjective symptoms as gold standard. METHODS: Inferior alveolar nerves were monitored neurophysiologically throughout mandibular osteotomy in 19 patients. Sensory disturbance was registered and sensation tested using clinical and quantitative sensory (QST) and neurophysiologic tests postoperatively at 1, 3, 6, 12 months...
December 14, 2018: Muscle & Nerve
(no author information available yet)
OBJECTIVEThe purpose of this study was to evaluate the technical feasibility, accuracy, and relevance on surgical outcome of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during resection of intradural extramedullary (IDEM) spinal tumors.METHODSClinical and intraoperative neurophysiological monitoring (IONM) data obtained in 108 consecutive patients who underwent surgery for IDEM tumors at the Institute for Scientific and Care Research "ASMN" of Reggio Emilia, Italy, were prospectively entered into a database and retrospectively analyzed...
November 1, 2018: Journal of Neurosurgery. Spine
Woo Hyung Lee, Chul-Kee Park, Hee-Pyoung Park, Sung-Min Kim, Byung-Mo Oh, Keewon Kim, Young-Doo Choi, Han Gil Seo
BACKGROUND: Dexmedetomidine (DEX) is used as an adjunct to total intravenous anesthesia. However, its effect on intraoperative neurophysiological monitoring (IOM) during brain tumor surgery remains controversial. The aim of this study was to explore the effect of DEX on IOM during brain tumor surgery. METHODS: Seventy eight consecutive patients (DEX group, n=40; control group, n=38), who underwent brain tumor surgery with IOM, were retrospectively reviewed. The outcomes included the predictability, laterality of alterations, and stimulation parameters of transcranial motor-evoked potentials (tcMEPs) and somatosensory-evoked potentials (SSEPs)...
November 26, 2018: World Neurosurgery
Luciano Mastronardi, Ettore Di Scipio, Guglielmo Cacciotti, Raffaelino Roperto, Carlo Giacobbo Scavo
BACKGROUND AND OBJECTIVE: Goals of small vestibular schwannoma (VS) microneurosurgery are as follows: radical resection, facial nerve (FN) preservation, and hearing preservation (HP). Microsurgical advances make HP possible in many patients with preoperative socially useful hearing (SUH). We evaluated postoperative HP in VS with maximum diameter < 2 cm monitored with two different auditory brainstem response (ABR) techniques. MATERIALS AND METHODS: Twenty-eight consecutive non-randomized patients with SUH suffering from small VS underwent keyhole microneurosurgery by retrosigmoid (RS) approach...
November 27, 2018: Acta Neurochirurgica
Kathryn Overzet, Mark Kazewych, Faisal R Jahangiri
Arthroscopic hip surgery is performed routinely for the treatment of various hip disorders. Leg traction during labral tear repair, femoroplasty, and acetabuloplasty for hip stabilization can stretch the peripheral nerves. This may cause temporary or permanent nerve injury. This study illustrates the benefit of utilizing multimodality Intraoperative Neurophysiological Monitoring (IONM) during hip surgical procedures. We performed a retrospective review of 10 arthroscopic hip surgeries with neurophysiological monitoring at one medical center...
September 22, 2018: Curēus
D B MacDonald, C Dong, R Quatrale, F Sala, S Skinner, F Soto, A Szelényi
Intraoperative somatosensory evoked potentials (SEPs) provide dorsal somatosensory system functional and localizing information, and complement motor evoked potentials. Correct application and interpretation require in-depth knowledge of relevant anatomy, electrophysiology, and techniques. It is advisable to facilitate cortical SEPs with total intravenous propofol-opioid or similarly favorable anesthesia. Moreover, SEP optimization is recommended to enhance surgical feedback speed and accuracy by maximizing signal-to-noise ratio (SNR); it consists of selecting highest-SNR peripheral and cortical derivations while omitting low-SNR channels...
November 14, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Mitchell T Foster, Lalgudi Srinivasan Harishchandra, Conor Mallucci
Pediatric neuro-oncology surgery continues to progress in sophistication, largely driven by advances in technology used to aid the following aspects of surgery: operative planning (advanced MRI techniques including fMRI and DTI), intraoperative navigation [preoperative MRI, intra-operative MRI (ioMRI) and intra-operative ultrasound (ioUS)], tumor visualization (microscopy, endoscopy, fluorescence), tumor resection techniques (ultrasonic aspirator, micro-instruments, micro-endoscopic instruments), delineation of the resection extent (ioMRI, ioUS, and fluorescence), and intraoperative safety (neurophysiological monitoring, ioMRI)...
2018: Frontiers in Pediatrics
Constanze Kiese, Hans-Peter Landgraf, Anna-Lena Danzer, Benedikt Schickling, Anna Nicolau-Torra, Torsten Reitmeier, Wilhelm Schulter-Mattler, Dietrich von Schweinitz, Herrmann Ketterl
The purpose of this study was to develop a user-friendly presentation of surface-EMG data in near-time for intraoperative nerve-monitoring. We have built a novel surface-EMG probe as a diagnostic device to investigate innervation patterns of sphincter muscles in further clinical diagnostic studies. S-EMG data were recorded from 20 healthy volunteers from the orbicularis oris muscles. We developed an automated analysis based on correlation in order to find phase inversions and thus innervation zones automatically...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Charis Khoo, A H NurHafiizhoh, Angela Tan, Tracy Tan, Hwan Ing Hee
BACKGROUND: The Auditory brainstem implant (ABI) is a new surgical option for hearing impaired children. Intraoperative neurophysiology monitoring includes brainstem mapping of cranial nerve (CN) IX, X, XI, XII and their motor nuclei, and corticobulbar tract motor-evoked potential. These require laryngeal electrodes and intra-oral pins, posing a challenge to airway management especially in the pediatric airway, where specialized electromyogram (EMG) tracheal tubes are not available. Challenges include determining the optimum position on the endotracheal tube (ETT) in which to place laryngeal electrode, and the increase in external diameter of ETT contributed by the wrapping the electrode around the shaft of ETT; this may necessitate downsizing of the tracheal tube...
November 7, 2018: BMC Anesthesiology
Mingzhe Zhang, Tetsuyoshi Horiuchi, Junpei Nitta, Raynald Liu, Yoshinari Miyaoka, Takuya Nakamura, Kazuhiro Hongo
BACKGROUND: There is still a controversy for low-flow extracranial-intracranial (EC-IC) or high-flow EC-IC bypass with proximal occlusion in the treatment of unclippable giant internal carotid artery aneurysms. CASE DESCRIPTION: A 61-year-old woman presented with a one-month history of double vision. Neuroimages revealed an unclippable giant internal carotid artery aneurysm located from the cavernous sinus to proximal site of the posterior communicating artery. Ipsilateral A1 of the anterior cerebal artery was hypoplastic and posterior communicating artery was patent...
November 1, 2018: World Neurosurgery
Jonathan H Chen, Andres A Gonzalez, Parastou Shilian, Justin Cheongsiatmoy
Transcranial electrical motor evoked potential (TcMEP) is a modality utilized in intraoperative neurophysiological monitoring to assess the integrity of the corticospinal tract. Traditionally, TcMEPs are obtained by anodal stimulation of the scalp over the motor cortex of the selected hemisphere and referenced to the contralateral hemisphere. Subsequent compound motor action potential responses (CMAPs) are recorded at various muscles. The muscle responses of interest are usually those recorded in the limb contralateral to the hemisphere of stimulation...
November 2, 2018: Neurodiagnostic Journal
Jun Hoe Kim, Ji Hoon Phi, Ji Yeoun Lee, Kyung Hyun Kim, Sung Hye Park, Young Hun Choi, Byung Kyu Cho, Seung Ki Kim
BACKGROUND: Recently, modern technology such as diffusion tensor imaging (DTI), neuro-navigation and intraoperative neurophysiological monitoring (IOM) have been actively adopted for the treatment of thalamic tumors. We evaluated surgical outcomes and efficacy of the aforementioned technologies for the treatment of pediatric thalamic tumors. METHODS: We retrospectively reviewed clinical data from 37 children with thalamic tumors between 2004 and 2017. There were 44 operations (27 tumor resections, 17 biopsies)...
October 2018: Brain Tumor Research and Treatment
Jeffrey H Gertsch, Joseph J Moreira, George R Lee, John D Hastings, Eva Ritzl, Matthew Allan Eccher, Bernard Allan Cohen, Jay L Shils, Michael T McCaffrey, Gene K Balzer, Jeffrey R Balzer, Willy Boucharel, Lanjun Guo, Leah L Hanson, Laura B Hemmer, Faisal R Jahangiri, Jorge A Mendez Vigil, Richard W Vogel, Lawrence R Wierzbowski, W Bryan Wilent, James S Zuccaro, Charles D Yingling
The American Society of Neurophysiological Monitoring (ASNM) was founded in 1989 as the American Society of Evoked Potential Monitoring. From the beginning, the Society has been made up of physicians, doctoral degree holders, Technologists, and all those interested in furthering the profession. The Society changed its name to the ASNM and held its first Annual Meeting in 1990. It remains the largest worldwide organization dedicated solely to the scientifically-based advancement of intraoperative neurophysiology...
October 30, 2018: Journal of Clinical Monitoring and Computing
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
Guillermo Martín-Palomeque, Lidia Cabañes-Martínez, Gema de Blas Beorlegui, M Del Mar Moreno Galera, Jaime R López, Francisco Javier Burgos, Ignacio Regidor Bailly-Baillière
PURPOSE: The occurrence of urinary incontinence and erectile dysfunction after surgical treatment for prostate cancer is a significant and lingering problem. The aim of this study is to revise and improve older techniques of intraoperative cavernous nerve mapping already in use to improve accuracy and reliability. METHODS: We prospectively studied this technique in 12 patients suffering from prostate cancer. Inhalation or intravenous anesthetic regimen was used with nondepolarizing muscle relaxants...
November 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Rodney Laing, Ivan Timofeev, Roberto Colasanti, Andrew Dean, Alessandro Di Rienzo
OBJECTIVE: Surgical treatment of ventrally located intradural cysts is difficult and controversial. Laminectomy with division of the denticulate ligaments and gentle cord mobilization remains the standard approach but risks further neurologic deterioration secondary to cord manipulation. Our purpose is to evaluate the safety and effectiveness of a midline cord-splitting approach as an alternative for treating ventral thoracic intradural cysts. METHODS: We describe 2 patients who were treated for ventral intradural cysts causing progressive and severe myelopathy...
October 5, 2018: World Neurosurgery
Özden Erhan Sofuoğlu, Anas Abdallah
BACKGROUND The aim of this study was to assess the clinical and radiological outcomes of surgical treatment for primary spinal ependymoma in children. MATERIAL AND METHODS Medical records of 46 primary spinal ependymoma patients who underwent surgery in BRSHH hospital during a 12-year period from 2004 to 2015 were retrospectively reviewed. All pediatric patients (patient age <18 years) were selected as the core sample used for this study. RESULTS This series included 1 female and 2 male patients between the ages of 9 and 17 years with mean age 13...
October 5, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Reza Ghadirpour, Davide Nasi, Corrado Iaccarino, Antonio Romano, Luisa Motti, Marco Farneti, Rosario Pascarella, Franco Servadei
Objective and Background: Data on intraoperative neurophysiological monitoring (IOM) during surgery of spinal dural arteriovenous fistulas (SDAVFs) are lacking. The purpose of this study was to evaluate the role of IOM during microsurgery for SDAVFs. Materials and Methods: From March 2007 to March 2013, 12 patients had microsurgery with IOM for SDAVFs. The IOM included somatosensory-evoked potentials, motor-evoked potentials (MEPs), and - in selected cases - D-Waves...
July 2018: Asian Journal of Neurosurgery
Sima Sayyahmelli, Ilhan Aydin, Bryan Wheeler, Mustafa K Baskaya
Although the surgical treatment of thalamic tumors remains challenging due to the proximity to the internal capsule, safe resection of gliomas or metastatic tumors of the thalamus are possible in some selected cases due to a better understanding of microsurgical anatomy and due to advances in neurophysiological mapping and monitoring. In this video, the authors demonstrate the use of mapping of the internal capsule with direct subcortical stimulation for the resection of a metastatic tumor. The patient is a 58-year-old man with a history of renal cell carcinoma and metastasis in the left thalamus and parieto-occipital region...
October 2018: Neurosurgical Focus
Parastou Fatemi, Michael Zhang, Kai J Miller, Pierre Robe, Gordon Li
PURPOSE OF REVIEW: Surgical treatment of brain tumors remains an integral part of a comprehensive treatment plan. Here, we review technological advances that have enhanced what surgeons are capable of doing within and outside the traditional operating room. RECENT FINDINGS: Extent of surgical resection has improved with the use of MRI and fluorescent dyes intraoperatively. Neurological injury during brain tumor surgery has decreased with appropriate use of neurophysiological monitoring...
September 26, 2018: Current Oncology Reports
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