intraoperative neurophysiology

INTRODUCTION: Gliomas are the second most frequent primary brain tumors. Surgical resection remains a crucial part of treatment, as well as maximum preservation of neurological function. For this reason awake surgery has an important role.The objectives of this article are to present our experience with awake surgery for gliomas in a South American center and to analyze how intraoperative functional findings may influence the extent of resection and neurological outcomes. MATERIALS AND METHODS: Retrospective single center study of a cohort of adult patients undergoing awake surgery for brain glioma, by the same neurosurgeon, between 2012 and 2022 in the city of Buenos Aires, Argentina...

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BACKGROUND: The treatment strategy for hemorrhagic moyamoya disease (MMD) due to a ruptured aneurysm at the distal portion of the anterior choroidal artery remains controversial. The authors successfully treated the ruptured aneurysm with neuroendoscopic hematoma evacuation, followed by endovascular coil embolization. OBSERVATIONS: The authors encountered two patients with massive hemorrhagic MMD whose MMD had already been diagnosed and who had a periventricular anastomosis due to a ruptured aneurysm of the distal portion of the anterior choroidal artery involving the periventricular anastomosis...

Intraoperative motor-evoked potentials (MEPs) are measured for assessing motor function during surgery. MEP monitoring is often performed in thoracoabdominal aortic aneurysm (TAAA) surgery, but false positives are common and amplification methods are needed to obtain waveforms under severe conditions to assess proper spinal cord function. One method of amplitude amplification in transcranial-stimulated MEP monitoring is multitrain stimulation. There are few reports on multitrain-stimulated MEP monitoring for this surgery...

OBJECTIVE: To evaluate the role of intraoperative neurophysiological monitoring (IONM) in reducing the postoperative neurologic deficit following corrective surgery of scoliosis. STUDY DESIGN: Observational Study. Place and Duration of the Study: Spine Surgery Department, Combined Military Hospital, Rawalpindi, from December 2022 to May 2023. METHODOLOGY: The study included 170 cases of scoliosis operated under multimodal IONM. Decreased amplitude of ≥50% in SSEP or 70-80% in MEPs were considered warning signs...

Elderly patients who undergo major surgery (not-neurosurgical) under general anaesthesia frequently complain about cognitive difficulties, especially during the first weeks after surgical "trauma". Although recovery usually occurs within a month, about one out of four patients develops full-blown postoperative Neurocognitive disorders (NCD) which compromise quality of life or daily autonomy. Mild/Major NCD affect approximately 10% of patients from three months to one year after major surgery. Neuroinflammation has emerged to have a critical role in the postoperative NCDs pathogenesis, through microglial activation and the release of pro-inflammatory cytokines which increase blood-brain-barrier permeability, enhance movement of leukocytes into the central nervous system (CNS) and favour the neuronal damage...

OBJECTIVE: To evaluate the diagnostic accuracy of intraoperative neurophysiological monitoring (IONM) during endovascular treatment (EVT) of ruptured intracranial aneurysms (rIA). METHODS: IONM and clinical data from 323 patients who underwent EVT for rIA from 2014-2019 were retrospectively reviewed. Significant IONM changes and outcomes were evaluated based on visual review of data and clinical documentation. RESULTS: Of the 323 patients undergoing EVT, significant IONM changes were noted in 30 patients (9...

Continuous Intraoperative Neurophysiologic Monitoring (cIONM) is a widely used technology to improve surgical outcomes and prevent cranial nerve injury during skull base surgery. Monitoring of free-running electromyogram (EMG) plays an important role in cIONM, which can be used to identify different discharge patterns, alert the surgeon to potential nerve damage promptly, etc. In this dataset, we collected clinical multichannel EMG signals from 11 independent patients' data using a Neuromaster G1 MEE-2000 system (Nihon Kohden, Inc...

PURPOSE: Determine peri-operative risk factors predictive for prematurely stopping surgery prior to completion of deformity correction due to intra-operative neuromonitoring changes. METHODS: A single institution retrospective review of adolescent idiopathic scoliosis (AIS) patients that underwent spinal fusion for curves greater than 70°. Cases aborted due to persistent loss of IONM were compared to completed cases. Demographic, radiographic, neurologic, and surgical information was reviewed...

Human reflexes are simple motor responses that are automatically elicited by various sensory inputs. These reflexes can provide valuable insights into the functioning of the nervous system, particularly the brainstem and spinal cord. Reflexes involving the brainstem, such as the blink reflex, laryngeal adductor reflex, trigeminal hypoglossal reflex, and masseter H reflex, offer immediate information about the cranial-nerve functionality and the overall state of the brainstem. Similarly, spinal reflexes such as the H reflex of the soleus muscle, posterior root muscle reflexes, and sacral reflexes provide crucial information about the functionality of the spinal cord and peripheral nerves...

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BACKGROUND: Brainstem mapping with electrical stimulation allows functional identification of neural structures during resection of deep lesions. Single pulses or train of pulses are delivered to map cranial nerves and corticospinal tracts, respectively. NEW METHOD: We introduce a hybrid stimulation technique for mapping the brainstem. The stimulus consists of an electrical single pulse followed by a short train of 3-5 pulses at 500Hz, at an interval of 50-75 ms...

OBJECTIVE: Analyze the usefulness, efficacy, and safety of transoperative Magnetic Resonance Imaging in glioma surgery in awake patients. MATERIALS AND METHODS: Retrospective, single-center, analytical study of a cohort of patients who underwent awake surgery for gliomas by the same surgeon in a third-level Argentine center, in the period between 2012-2022. Only patients with pathology-confirmed gliomas, with 6-month follow-up, who had pre and postoperative volumetric MRI, were included in this sample...

OBJECTIVE: This study aimed to evaluate the potential alleviation of quadriceps spasticity in children diagnosed with spastic cerebral palsy (CP) following selective dorsal rhizotomy (SDR). METHODS: A retrospective study was conducted on children suffering from spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children's Hospital, from July 2018 to September 2020. Inclusion criteria comprised children exhibiting quadriceps spasticity exceeding modified Ashworth Scale grade 2...

BACKGROUND: Intraoperative neurophysiological monitoring (IOM) is a valuable adjunct for neurosurgical operative techniques, and has been shown to improve clinical outcomes in cranial and spinal surgery. It is not necessarily provided by NHS hospitals so may be outsourced to private companies, which are expensive and at cost to the NHS trusts. We discuss the benefits and challenges of developing an in-house service. METHODS: We surveyed NHS neurosurgical departments across England regarding their expenditure on IOM over the period January 2018 - December 2022 on cranial neurosurgery and spinal surgery...

INTRODUCTION: Intraoperative neuroelectrophysiology monitoring (IONM) has been used to decrease complications and to increase the successful rate of microvascular decompression (MVD) MVD for hemifacial spasm (HFS). Still, it is not available at limited resource centers. We report the outcome of patients undergoing MVD for HFS without using IONM. MATERIALS AND METHOD: The variables concerning the patients' demographics (age and gender), clinical characteristics, offending vessels (vertebral artery type and non-vertebral artery type), postoperative grade of hemifacial spasm, and postoperative complications of HFS patients undergoing MVD were retrospectively reviewed and collected...

BACKGROUND: Functional role of filum terminale (FT) was not well studied though it contains structure basis for nerve impulse conduction. We aimed to explore the possible functions of the FT from the perspective of triggered electromyography (EMG) during surgery. METHODS: We retrospectively reviewed intraoperative neurophysiological monitoring data from pediatric patients who underwent intradural surgeries at the lumbar level in Shanghai Children's. Hospital from January 2018 to March 2023...

RATIONALE: The incidence of a schwannoma within the psoas muscle is rare, and only a few cases have been reported. The surgical approach to removing schwannomas present in the psoas muscle is challenging because of its anatomical proximity to the lumbar plexus. PATIENT CONCERNS: A 31-year-old man experienced right lower back pain and anterolateral thigh numbness for 2 months. DIAGNOSIS: Magnetic resonance imaging of the patient's lumbar spine revealed a mass lesion, which was radiologically diagnosed as a well-demarcated schwannoma...

Meningiomas are one of the most common intradural extramedullary tumors.1 Symptoms often arise from cord compression, with gross total resection leading to the most optimal patient outcomes.2,3 Utilization of intraoperative neurophysiological monitoring can increase patient safety through real-time assessment of neural structures and reduce postoperative neurologic complications.4 In this video, we describe the operative techniques for the resection of a meningioma located at the cervico-thoracic junction. A 43-year-old female patient presented with 6 months of bilateral leg numbness and gait disturbances...

INTRODUCTION: Spina bifida occulta has a variety of symptoms that may hinder the diagnosis and subsequently delay appropriate treatment, causing a decrease in the patient's quality of life. This study aims to shed light on spina bifida occulta, with chronic low back pain as the predominant symptom, and the treatment applied in this case. PRESENTATION OF CASE: A 46-year-old male was diagnosed with spina bifida occulta at the 5th lumbar spine after 2 years of having chronic low back pain that radiated to the left leg...