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Intraoperative Neurophysiologic Monitoring

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...
August 8, 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...
August 4, 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...
July 20, 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 <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 >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
Sanghyun Han, Yong Chul Kwon, Sung-Min Kim, Seung-Jae Hyun, Tae-Ahn Jahng, Ki-Jeong Kim, Hyun-Jib Kim, Kyung Seok Park, Ho Yong Choi, Young-Seop Park
OBJECTIVE: The aim of study is to determine the risk factors affecting intraoperative neurophysiological 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 (CCM). METHODS: Between 2010 and 2015, 79 patients who underwent COL with IONM recording were studied. Changes in MEPs or SSEPs over an alarm criterion were defined as IONM change...
July 23, 2018: World Neurosurgery
Jose Gomez-Tames, Akimasa Hirata, Manabu Tamura, Yoshihiro Muragaki
Intraoperative neurophysiological monitoring during brain surgery uses direct cortical stimulation to map the motor cortex by recording muscle activity induced by the excitation of alpha motor neurons (MNs). Computational models have been used to understand local brain stimulation. However, a computational model revealing the stimulation process from the cortex to MNs has not yet been proposed. Thus, the aim of the current study was to develop a corticomotoneuronal (CMN) model to investigate intraoperative stimulation during surgery...
June 18, 2018: International Journal of Neural Systems
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 glioma patients following intraoperative neurophysiological monitoring (IONM) application. METHODS: 856 glioma patients, who underwent tumor resection between October 2010 and March 2016, were included in this retrospective cohort study. All patients were stratified into IONM (439 cases) and non-IONM group (417 cases). The primary outcome measured was overall survival (OS), and the secondary outcome measured was rate of late neurologic deficits...
July 16, 2018: World Neurosurgery
Jeremy A Lieberman, Russ Lyon, Paul Jasiukaitis, Sigurd H Berven, Shane Burch, John Feiner
STUDY DESIGN: Case-control analysis of transcranial motor evoked potential (MEP) responses and clinical outcome. OBJECTIVE: To determine the sensitivity and specificity of MEPs to predict isolated nerve root injury causing dorsiflexion weakness in selected patients having complex lumbar spine surgery. SUMMARY OF BACKGROUND DATA: The surgical correction of distal lumbar spine deformity involves significant risk for damage to neural structures that control muscles of ankle and toe dorsiflexion...
July 16, 2018: Spine Journal: Official Journal of the North American Spine Society
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...
July 16, 2018: Current Opinion in Anaesthesiology
Patricia Lavand'homme, Jean-Pierre Estebe
PURPOSE OF REVIEW: In the past two decades, opioids have been prescribed increasingly for the treatment of various chronic pain conditions and during the perioperative period. Perioperative opioid administration is associated with well known adverse effects and recently to long-term use and poor surgical outcomes. In this context, the anesthesiologists have to face their responsibilities. The review discusses the neurophysiological basis of opioid-free anesthesia (OFA), the rational supporting its use in perioperative medicine as well as barriers and future challenges in the field...
July 9, 2018: Current Opinion in Anaesthesiology
Ritesh Lamsal, Girija P Rath
PURPOSE OF REVIEW: Pediatric neuroanesthesia is a fascinating, yet challenging branch of anesthesia. This review highlights some of the recent insights into pediatric neuroanesthesia from the past 18 months. RECENT FINDINGS: Although there are incontrovertible evidences in animals suggesting that prolonged exposure to general anesthesia causes long-term neurological impairment, the translational relevance of these findings in humans is debatable. Early surgery for pediatric drug-refractory epilepsy is supported by emerging literature, but poses unique perioperative problems for the treating neuroanesthesiologist...
July 4, 2018: Current Opinion in Anaesthesiology
Jonathan H Chen, Parastou Shilian, Justin Cheongsiatmoy, Andres A Gonzalez
PURPOSE: Intraoperative neurophysiologic monitoring involves the use of various modalities, including somatosensory evoked potentials (SEP), to assess the integrity of the at-risk nervous system during surgeries. Reliable baseline tracings are important because they are data against which future tracings are compared to detect potential injury. In some cases, adequate baselines may be difficult to achieve. Therefore, we analyzed several patient-specific factors to determine which variables are associated with inadequate intraoperative SEP baseline signals...
June 21, 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Tucker Johnson, Emily B Kale, Aatif M Husain
Motor evoked potentials (MEPs) are commonly used during neurophysiologic intraoperative monitoring. Anesthetic, homeostatic, surgical, and technical factors can cause a change in MEPs. The authors describe a case in which a bolus of magnesium sulfate resulted in a loss of amplitude of MEPs. Responses returned to near baseline about 20 minutes later. The patient did not have any new postoperative deficits. When MEP changes occur, in addition to evaluating other causes, magnesium sulfate administration should be considered...
2018: Neurodiagnostic Journal
Andres A Gonzalez, Justin Cheongsiatmoy, Parastou Shilian, Pooja Parikh
PURPOSE: Successful intraoperative neurophysiological monitoring is predicated on the presence of adequate baseline-evoked potentials. We have observed that transcranial motor evoked potentials (TcMEPs) yield more robust responses in the distal muscles compared with proximal muscles. One possible explanation is the distance from the needle to the muscle generator. In this study, we investigate whether TcMEP amplitudes from the rectus femoris muscle are affected by changes in needle length...
June 5, 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Lilia Cristina De la Maza-Krzeptowsky, Gabriela Romero-Esquiliano, Eduardo H Ramírez-Segura, Enrique De Obieta-Cruz, Alfonso Vega-Sosa, Alexander Cárdenas-Mejía, Daniel San Juan-Orta, Margot Castillo-Herrera, Sergio J Aguilar-Castillo, Mario U Ávila-Ordóñez, Luz M Cordero-Guzmán, Rosa E Escobar-Cedillo, María I Fraire-Martínez, Marisela O Franco-Lira, José J González-Jaime, Claudia E Paz-Navarro, Jaime N Ramos-Peek, Paul Shkurovich-Bialik, Pedro Silva-Cerecedo, C Armando Tello-Valdés, Álvaro A Zavala-Reina, Jaime López-Rodríguez, Ojino Sosa-García
Introduction: Intraoperative neurophysiological monitoring (IONM) is a procedure that uses neurophysiological techniques in order to evaluate the motor and sensitive systems during surgeries that endanger the nervous system. Method: The approach, scope, target population, and clinical questions to be answered were defined. A systematic search of the evidence was conducted step by step; during the first stage, clinical practice guidelines were collected, during the second stage systematic reviews were obtained, and during the third stage, clinical trials and observational studies were procured...
2018: Cirugia y Cirujanos
Anna Lorenzen, Samuel Groeschel, Ulrike Ernemann, Marko Wilke, Martin U Schuhmann
PURPOSE: Presurgical functional MRI (fMRI) and diffusion MRI tractography (dMRI tractography) are widely employed to delineate eloquent brain regions and their connections prior to brain tumor resection in adults. However, such studies are harder to perform in children, resulting in suboptimal neurosurgical care in pediatric brain tumor surgery as compared to adults. Thus, our objective was to assess the feasibility and the influence of presurgical advanced MR imaging on neurosurgical care in pediatric brain tumor surgery...
May 25, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Thomas Noh, Manuel S Vogt, David W Pruitt, Trent R Hummel, Francesco T Mangano
PURPOSE: The Functional Independence Measure for children (WeeFIM) is a user-friendly functional outcomes tool that has been validated across other traditional functional scales. Historically, the significant neurologic and functional deficits of intramedullary spinal cord tumors (IMSCTs) have been monitored by coarse or overbearing functional outcomes tools that make it difficult to measure the slow improvement/decline seen in these patients. This study is the first to report WeeFIM outcomes on a series of IMSCTs with emphasis on an aggressive surgical strategy...
May 25, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Guilherme H W Ceccato, Lucélio Henning, Julyana L Prado, Marcio S Rassi, Luis A B Borba
Solitary spinal epidural cavernous angiomas are rare vascular malformations. Surgical excision is the treatment of choice, as these lesions tend to grow or bleed at some point. In this 3-dimensional, narrated video, we present the case of a 61-year-old male who presented with progressive pain in the right paravertebral region secondary to an epidural cavernous angioma located at the T6/T7 level. Under intraoperative neurophysiological monitoring, a laminectomy between T5 and T7 was performed. A reddish, well delimited, and highly vascularized epidural mass was identified and dissected from the adjacent dura and nerve root, and an en bloc total resection was achieved...
May 21, 2018: Operative Neurosurgery (Hagerstown, Md.)
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