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Intraoperative Neurophysiologic Monitoring

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...
October 10, 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 neurological 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 two patients who were treated for ventral intradural cysts causing progressive and severe myelopathy...
October 4, 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
Stephanie L Schwartz, Emily B Kale, Aatif M Husain
Somatosensory evoked potentials (SEPs) using tibial nerve stimulation are used during neurophysiologic intraoperative monitoring (NIOM). These SEPs produce a P37 waveform that is recorded from scalp electrodes. In this study, we attempted to determine the best derivation for recording the P37 waveform. Surgical cases using tibial nerve SEP NIOM were reviewed. Only cases in which the P37 was recorded using all of the following derivations were analyzed: centroparietal ipsilateral-centroparietal contralateral (CPi-CPc), centroparietal midline-frontopolar midline (CPz-Fpz), and CPz-CPc...
2018: Neurodiagnostic Journal
Andrey Rostislavovich Sitnikov, Yuri Alekseevich Grigoryan, Lidiya Petrovna Mishnyakova
Background: The use of awake craniotomy for surgical treatment of epilepsy was applied in surgery of convexital tumors, arteriovenous malformations, some superficial aneurysms, and stereotactic neurosurgery. The aim of this study was to show the advantages of awake craniotomy without sedation, accompanied by intraoperative neurophysiological monitoring in patients with symptomatic epilepsy. Methods: This article describes the results of surgical treatment in 41 patients with various pathologies; 31 among them suffered from epilepsy...
2018: Surgical Neurology International
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
Jonathan A Norton, Lissa Peeling, Kotoo Meguro, Mike Kelly
Objective: To describe the changes in the shape and topology of the somatosensory evoked potential (SSEP) during carotid endarterectomy, with particular reference to the time of clamping. Methods: Routine intraoperative monitoring was performed on 30 patients undergoing carotid endarterectomy (15) or undergoing stenting (15) using median nerve SSEPs. Post-operatively the first and second derivatives of the potential were examined. Separate analysis of the SSEP using wavelets was also performed...
2018: Clinical Neurophysiology Practice
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
Alberto Pasqualin, Pietro Meneghelli, Angelo Musumeci, Alessandro Della Puppa, Giacomo Pavesi, Giampietro Pinna, Renato Scienza
Intraoperative flowmetry (IF) has been recently introduced during cerebral aneurysm surgery in order to obtain a safer surgical exclusion of the aneurysm. This study evaluates the usefulness of IF during surgery for cerebral aneurysms and compares the results obtained in the joined surgical series of Verona and Padua to the more recent results obtained at the neurosurgical department of Verona.In the first surgical series, between 2001 and 2010, a total of 312 patients were submitted to IF during surgery for cerebral aneurysm at the neurosurgical departments of Verona and Padua: 162 patients presented with subarachnoid hemorrhage (SAH) whereas 150 patients harbored unruptured aneurysms...
2018: Acta Neurochirurgica. Supplement
Ignazio G Vetrano, Davide Bagatti, Roberto Cordella, Irene Tramacere, Vittoria Nazzi
BACKGROUND: Decompression and, when necessary, neurolysis in entrapment neuropathies of upper limbs are effective and safe procedures, but their correlation with the variation of compound muscle action potentials (CMAPs) is still unclear, based in particular on experimental models. In addition, there are few data regarding the efficacy of intraoperative neurophysiologic monitoring (IOM) to predict clinical early and late outcome after surgery in term of pain control and sensitive/motor recovery...
August 28, 2018: Journal of Neurosurgical Sciences
Jose L Sanmillan, Pablo Lopez-Ojeda, Isabel Fernández-Conejero, Alejandro Fernández-Coello, Gerard Plans, Yara Ali-Ciurana, Andreu Gabarrós
BACKGROUND: Eloquent area surgery has become safer with the development of intraoperative neurophysiological monitoring and brain mapping techniques. However, the usefulness of intraoperative electric brain stimulation techniques applied to the management and surgical treatment of cavernous malformations in supratentorial eloquent areas is still not proven. With this study, we aim to describe our experience with the use of a tailored functional approach to treat cavernous malformations in supratentorial eloquent areas...
October 2018: Acta Neurochirurgica
David P Martin, Walter P Samora, Allan C Beebe, Jan Klamar, Laura Gill, Tarun Bhalla, Giorgio Veneziano, Arlyne Thung, Dmitry Tumin, N'Diris Barry, Julie Rice, Joseph D Tobias
PURPOSE: To provide optimal conditions for neurophysiological monitoring and rapid awakening, remifentanil is commonly used during pediatric spinal surgery. However, remifentanil may induce hyperalgesia and increase postoperative opioid requirements. We evaluated the potential of methadone or magnesium to prevent remifentanil-induced hyperalgesia. METHODS: Using a prospective, randomized, blinded design, adolescents presenting for posterior spinal fusion to treat idiopathic scoliosis were assigned to receive desflurane with remifentanil alone (REMI), remifentanil + methadone (MET) (0...
October 2018: Journal of Anesthesia
Alfredo Traba, Juan Pablo Romero, Beatriz Arranz, Concepción Vilela
OBJECTIVE: Our objective is to use the area of the motor evoked potential (MEP) as a diagnostic tool for intraoperative radicular injury. METHODS: We analyzed the intraoperative neurophysiological monitoring data and clinical outcomes of 203 patients treated for dorsolumbar spine deformity. The decrease in amplitude was compared with the reduction in the MEP area. RESULTS: In 11 cases, new intraoperative injuries occurred, nine of them were lumbar radiculopathies...
October 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
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
Mehmet Nuri Erdem, Ismail Oltulu, Sinan Karaca, Seçkin Sari, Mehmet Aydogan
STUDY DESIGN: A retrospective clinical study. PURPOSE: To analyze the surgical outcomes of intraoperative halo-femoral traction (HFT) in patients with adolescent idiopathic scoliosis (AIS) with Cobb angles between 70° and 90° and flexibility &lt;35%. OVERVIEW OF LITERATURE: Numerous methods have been described to achieve adequate correction and successful results in the surgical treatment of AIS patients with a Cobb angle &gt;70°...
August 2018: Asian Spine Journal
Jürgen Beck, Andreas Raabe, Wouter I Schievink, Christian Fung, Jan Gralla, Eike Piechowiak, Kathleen Seidel, Christian T Ulrich
BACKGROUND: Spinal cerebrospinal fluid (CSF) leaks are the cause of spontaneous intracranial hypotension (SIH). OBJECTIVE: To propose a surgical strategy, stratified according to anatomic location of the leak, for sealing all CSF leaks around the 360° circumference of the dura through a single tailored posterior approach. METHODS: All consecutive SIH patients undergoing spinal surgery were included. The anatomic site of the leak was exactly localized...
July 25, 2018: Neurosurgery
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